Comment by rsweeney21 | Hacker News Reader

Comment by rsweeney21 | Hacker News Reader

The criminal justice system should not handle these cases. I don't consider acts done by mentally ill people criminal. I have personal experience with this.

My sister is bipolar and schizophrenic. For 30 years she was a little quirky, but mostly normal. She worked at a private equity firm in New York, got married, had a great life. Something changed around age 30. She started acting strange. We initially thought it was just her normal quirkyness, but then things started to escalate. She wouldn't stop talking about Prince Harry. She said she wanted to marry him. We laughed it off.

Then she started talking about secret messages she was receiving from Prince Harry. She believed she had been chosen as the princess and that ISIS was trying to kill her to prevent Prince Harry from marrying her. She had all this proof (hidden messages in the news, Instagram posts of bananas, crazy stuff). She was convince that the government had put chips in our brains and were controlling us. We realized that she needed help, but she refused to believe she had a mental illness. There was absolutely nothing we could do BEFORE she committed a crime. We knew it would happen, we knew it was only a matter of time, but the criminal justice system would not do anything.

Finally, on Christmas day, she went on a rampage at my grandmas house and destroyed a bunch of property. (We found a journal entry later where she said she was sad because Santa Clause didn't come and pick her up and take her to the North Pole like he was supposed to so she lost it.) We got lucky that it was only property. She was put in jail for 24 hours and then let out on the street at midnight without us knowing. She assaulted a police officer the next day. She thought he was ISIS trying to kill her.

FINALLY, the criminal justice system did something. We had to hire lawyers to plead with the judge to force her on to medication. We had stacks of tweets, facebook messages, emails, etc that showed she was clearly delusional. They finally agreed.

She is on meds now and has regular checkins with her parole officer to ensure she stays on them. She is back to being a little quirky, but has no more delusions. She has a job again and is happy.

We are lucky. It could have ended up a lot worse. The current system for helping the mentally ill is totally broken.

> The current system for helping the mentally ill is totally broken.

It is. But it's possible for it to be broken in the opposite direction, too - mom's getting a little funny in old age, mom has lots of assets, kids get her declared mentally incompetent to get their hands on her assets without having to wait for her to die first. Or a hundred variants on that theme - using declarations of mental illness as a tool to control or remove people that you have no right to control or remove.

The current system is broken. But be careful and cautious with proposed fixes.

False positives is always the reason why limits and controls are absolutely important.

>I don't consider acts done by mentally ill people criminal

I do.

The harm is being done and the crime is being committed regardless of motivation, mental state, or ignorance of the law. Semantics can be argued all day, but the end result is a harm on society.

The issue is the criminal justice system will just throw them behind bars and do nothing else. Prison is basically "We don't know what else to do with you so we'll throw you in here and hope you get better by the time you come out, but not actually do anything to make you better... also you will probably be raped and beaten while in there."

If criminal justice was actually about getting people the help they need rather than doing time, that'd be totally different.

This assumes everyone wants to get better. As demonstrated here, not everyone does: https://youtu.be/bpAi70WWBlw?t=913

What do you do in cases like that if prison is off the table?

The issue is prison is about "doing time". If someone doesn't want to "get better" then that is the thing you treat.

I didn't watch the video mostly because I don't know what it contains and I have kids around. Making the assumption that it's about people who want to be homeless, honestly that's fine. There's nothing inherently wrong about being homeless if that's what you want. The problem is people causing public health issues because they defecate in public areas, tear apart trash bins, or cause other issues like attacking other people... none of which is acceptable to society. These people may not want to be part of society, but they are living where society exists.

If you have a chance to watch the video, I'd recommend it (it's about 1h, as a heads up). It is certainly mature themed, so may not be suitable for younger viewers, but it is a news station-produced segment/doc (KOMO in Seattle), so is not wildly inappropriate, and I found it to be a fascinating and hard look at a real problem. (In fact, the first thing I did when I saw this thread was ctrl+F "yout" to find out if anyone had already posted it).

The video explores the visibly-homeless issue in Seattle, as well as a program to address the problem that was implemented in Rhode Island (specifically, enforcement + long-term treatment). I found it worth the watch.

Oh is it "Seattle is dying"? Have definitely been meaning to watch that.

Yep, that's the one.

You put people in hospital as patients getting treatment, rather than in prison as convicts being punished.

So putting the other hospital patients and nurses at risk? Western State Hospital has regular assaults against the staff and other patients.

You can create hospitals that are designed to treat people who are mentally ill.

I get where you are coming from, but mental state is an element of just about every criminal law I can think of. You need to prove both that someone committed an act and had a certain "mens rea." That doesn't mean you can't commit a crime if you're on drugs or have other mental issues, but it's a relevant factor.

> You need to prove both that someone committed an act and had a certain "mens rea."

Only sometimes, and only for some crimes. It really is rather complicated. Legal philosophy recognizes that the primary purpose of punishments for crime is to deter people from committing crimes, and it therefore doesn't make sense to punish people who are too mentally ill to understand (a) what they were doing, or (b) that it was wrong, or (c) that they would be punished, or (d) what 'punishment' even is.

But legal philosophy is not a wasteland of common sense, and it's also recognized that one of the purposes of punishment for crimes is to prevent recurrence by making it impossible. The legal authority of the state to indefinitely imprison people who are dangerous to others through no fault of their own is well established.

The current system in California / some other states are broken.

From personal experience, in Illinois, someone can receive hospital care involuntarily if the doctors deem that they would deteriorate without intervention / become dangerous to others.

One look at the differences in law between the two is illustrative:

In CA -

To qualify for mandated treatment in a hospital or other inpatient facility, the person must be:

- dangerous to self/others; or - unable to provide for basic personal needs for food, clothing, or shelter.

in IL:

- be a reasonable expectation of danger to self/others - be unable to provide for basic physical needs so as to guard against serious harm without the assistance of others, OR - refuse or not adhere to treatment, unable to understand need for treatment, and, if not treated, reasonably expected to suffer mental or emotional deterioration and become dangerous and/or unable to provide for basic physical needs

Your sister conceivably wouldn't have reached that state because once she reached the stage in paragraph 3, if you brought her to a hospital in IL, a evaluation would've determined that she should be involuntarily hospitalized, and she would've received medication.

I know a schizophrenic woman who was committed to involuntary psychiatric hold in California in just about every decade from the 1960s through 1990s, each time she had psychotic breaks. These would be some number of weeks before transitioning to periodic out-patient care.

To my knowledge, she was never really aggressive, violent, nor into self-harm. She was only a risk to herself or her children due to impaired decision making. Her encounters with law enforcement would be things like running a red light while in a delusional panic or because she called to report imaginary prowlers. I think her family and doctor were instrumental in getting her committed when she resisted treatment and her condition regressed. It's possible that her first encounters in the 1960s happened when the system was more willing to declare someone unfit, and then her existing history made it easier to repeat the process in later decades. It takes someone to track and pursue, rather than just expecting some random public servant to recognize the need based on one transient encounter with the case.

But, it was also her family that kept her going outside the brief psychiatric holds. This supportive environment is what seems to be most lacking in modern society, but also is the least feasible for the state itself to provide. I don't see how you can expect much better than the kind of institutional living that has been dismantled. How many patients have to share one doctor, nurse, or orderly?

And, from what I know of this woman, even her successful case took a huge toll on those family members who provided ongoing support. Where can the state find caregivers to provide similar effort for all the less fortunate patients who do not have the supporting family or friends?

The purpose of the criminal justice system is to protect the public. When mentally ill people present a danger to the public then the criminal justice system should be involved.

I have no personal experience with mental illness, but judging by your story it seems that part of the problem was your sister's lack of willingness to seek help. Most health insurance plans cover some kind of mental health services, but the afflicted person must actively seek out such help. Compare this with a broken leg: if I stepped wrong off the curb and broke my leg, I'd be in in pain and clearly unable to walk. I would call 911 and have them pick me up, take me to a hospital, patch me up, etc. The system to make all of that happen is there.

It would appear that mentally ill individuals are unable to seek help. Is it not the case that psychiatrists and mental hospitals exist and are covered by health insurance? It seems unfair to point the finger only at the system without acknowledging that helpers can't help without explicit consent on the part of the person being helped, or without some legal means by which they can be coerced to accept help.

The crucial point is that the sister did not think she needed help. She had to be 'pushed' into it.

And that's the crux-at what point do we do for them what they can't/won't do for themselves?

> I have no personal experience with mental illness, but judging by your story it seems that part of the problem was your sister's lack of willingness to seek help.

Would you be willing to take serious anti-psychotic medication, with significant side effects, if you were 100% certain you were perfectly sane?

Or, say, 90% certain that you are perfectly sane?

I for one am currently 100% certain that I'm perfectly sane, but that's just my opinion, which, on balance, is worth about as much as the opinion of the homeless guy on Broadway who yells at passersby all day long. I'm sure he also thinks he's perfectly sane. Both such opinions are extremely subjective. In fact, I'd brand as psychotic anyone possessing enough audacity to diagnose me with mental illness. How dare they suggest that I've lost my marbles?

So, to answer your question: no, I'm not willing to take drugs, because I'm 100% certain that I'm perfectly sane.

IMHO this is what makes the mental health conversation so difficult: we don't all seem to share a consistent worldview in the best of times, let alone when one's mental faculties are impacted by illness. How can we find neutral cognitive ground where a mentally ill person can be brought up to speed with the Objectively So?

I suspect that the level of trust and compassion required to do this can only materialize in a family setting. I also find it ironic that the absence of a solid familial fabric is surely a significant contributor to mental illness to begin with.

> I suspect that the level of trust and compassion required to do this can only materialize in a family setting. I also find it ironic that the absence of a solid familial fabric is surely a significant contributor to mental illness to begin with.

Hard to imagine a familial fabric more solid than the Kennedy dynasty, and yet...

https://en.wikipedia.org/wiki/Rosemary_Kennedy

Straitjackets are also made of fabric.

> I have no personal experience with mental illness, but judging by your story it seems that part of the problem was your sister's lack of willingness to seek help.

That's kind of the problem though. You can't just blame someone who is mentally ill for not seeking help. In the UK, for example, you can be sectioned.

"The Mental Health Act says when you can be taken to hospital, kept there, and treated against your wishes. This can only happen if you have a mental disorder that puts you, or others, at risk.

You should only be detained under the Mental Health Act if there are no other ways to keep you, or others, safe."

https://www.rethink.org/advice-and-information/rights-restri...

The law says nearly the exact same thing in California (and I'd guess most of the US). Is there a substantial difference in the way it's applied in practice in the UK?

In England the most commonly used bits of the mental health act are Section 2 (28 day hold for assessment and treatment), Section 3 (6 month hold for treatment) and Section 136 ( a police officer can take someone from a public place to a place of safety for a 24 hour hold for assessment). There are also forensic sections of the act and there are community treatment orders.

Section 2 and 3 require two doctors and an approved mental health professional (AMHP). One of the doctors has to be specially trained in using the MHA. The other doctor should be someone who knows the patient. The AMHP is usually a social worker who knows the mental health act law and is there to protect the rights of the patient.

There are legal requirements placed on the patient's local MH Trust. One of these is that when that patient's nearest relative tell the trust about concerns and asks for an assessment under the act then the trust must consider that request.

A person detained under the act is provided with an advocate from an independent advocacy service. This is free legal advice. If they feel they are being unjustly detained they can go to tribunal to get the section overturned. And that process is also open to relatives too.

There are no fears that your loved one will be shot and killed if you involve the police.

I don't know anything about the US law, but it seems somewhat complex and expensive. There are laws at the state level, and at the county level. Some states say that the harm to self or others must be "imminent" which is a pretty high barrier to meet. Most states allow a forced treatment in the community option, but California requires the counties to adopt that law. So for California where you live decides whether your family can ask the courts to force you to take medication in the community.

When someone has an illness that affects their brain you're saying they should both be aware of the illness and then seek help for the illness? They should use the logic and reasoning capabilities of said brain, with an illness, to achieve this.

Think about what you're saying. Really think about it. Your broken leg comparison completely misses the mark. How about this scenario?

You are walking and step into the street. You are hit by a bus but survive. You have massive head trauma. At this point nobody else should administer care without first speaking with you and having you acknowledge that you need care. You need to then respond in a coherent manner that explicitly allows you to be cared for before anyone is legally allowed to help you. How do you think that is going to work out for you?

To make this a bit more on point, try jogging back to the ER after breaking that leg. That's what essentially you are asking of people

> without explicit consent on the part of the person being helped

But that's part of the brokenness of the system being complained about.

We need to be careful about compulsory treatment and detention without trial, but other countries manage it without it being catastrophic - at least not as catastrophic as leaving people addicted to drugs, mentally ill, and living on the street.

Anosognosia[0] is a typical aspect of many mental illnesses. If they knew the delusions weren't real, they wouldn't really be delusions.

There is a fundamental hard problem here that many people who think there are easy solutions ignore: how do we as a society fairly determine who can have their autonomy taken from them? Where do we draw the line between personal responsibility, mental illness, and willful criminal intent?

In the past, the line was drawn too far towards the state and family and there were innumerable horror stories of "difficult" women being lobotomized and locked up in sanitoria for life because their family didn't want to deal with their rebellious ways.

The deinstitutionalization movement swung the pendulum the other way and said, basically, you're completely responsible for yourself all the way up until you commit an actual crime. Because criminality is now the line, it means the police end up dealing with the mentally ill more than they should.

The right point is somewhere between these, but drawing it fairly is hard and we don't have great social structures to support it. (In particular, how does society allow the medical infrastructure decide who should have autonomy in a country that doesn't even provide any right to medical access in the first place?)

[0] https://en.wikipedia.org/wiki/Anosognosia

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