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I would add that besides the police we outsource a lot of this stuff to public transportation workers and librarians. All night subways operate as mobile shelters, especially in winters and libraries are frequently the only place a homeless person can stay during the day without getting kicked out or interacting with the police. Unfortunately we don't really prepare transportation/library workers with the resources to deal with them most of the time.

Agreed 100%. And forget even having a place to be. Just finding a place to answer the call of nature is a problem. America, where if you don't have money, it's a crime to piss anywhere but in your pants.

That sounds more like Bern or Paris (where their is a lack of free public restrooms) rather than the USA. What am I missing?

I think you're missing that most of the homeless presence is in specific areas, like downtown, where there are not many free restrooms.

Private businesses see a lot of abuse of their restrooms — from people using them and not paying for anything, but also because they make good places to do drugs, and it's common for homeless to overstay their welcome and/or damage the facilities. As a result, many businesses put locks on them and require that paying customers ask for a code.

There are a few publicly provided restrooms, but they tend to be few, far between, and in pretty sorry disrepair. In SF for example, you can find restrooms in parks and libraries, but they're often a mess. There are some single use restrooms on the street that were designed to provide autonomous self-cleaning public facilities, but because of abuse, nowadays they're mostly either out-of-order or have a full-time worker to babysit them (also, there's not many of them, and there throughput is very low).

Seattle has free public restrooms, even public with a P, at the market for example (though no stall doors because drugs, which is really weird).

I would also add hospitals and ER departments.

> And you must give those institutions some power to intervene sometimes against the will of those they are intervening with. And I have no illusions. Involuntary commitment to mental health care and drug treatment and community involvement are often ugly but Americans make it clear over and over that even though vagrants and homeless are generally not a problem that much affects those other than the vagrants and homeless themselves we will never collectively tolerate their presence.

It might be worth reviewing why Americans turned so harshly against involuntary commitment to mental health care institutions. It was a parade of horrors that made Abu Ghraib look like Disney World. Convincing people that we'll get it right, reliably, at massive scale this time around is something of a daunting task.

Oh I 100% agree. We deinstitutionalized for good reason. I will say two things however. Medical ethics and legal protections have come a long way since then. You wouldn't see doctors straight up experimenting on people at least not with legal sanction and the state now has an obligation to provide people attorneys. So using your own lawyer to get aunt Elsa committed while she just at the mercy of the system wouldn't be so easy.

But I would hope that with knowing what we do now about mental illness we would have many layers of intervention before we get to that level.

Imagine if theirs a kid getting into trouble regularly at school because of their mental health status. Rather than wait until that turns into a violent episode that gets the kid in jail or committed the court could assign that kid a mentor. Someone they have to spend 10 hours a week with and who they can call on for anything. That can change the trajectory of a kid's life. We know this because the number one difference between people with mental illness that succeed and those that fail is whether they have a support network.

Court mandated mentoring, support networks and counselling before, not after a major incident are all relatively low touch interventions that would be hugely beneficial. And we do some of this now. It just mostly comes after the criminal justice system has already begun to see the person as a criminal because it usually follows a significant crime.

Of course this cuta against the American psyche. We want to have 100% all our rights with no government intervention until we've proved we shouldn't. Then the government should have radical powers to shape our lives.

But maybe if we could come to see government more like the way doctors see medical treatment. The more unobtrusive it is the more we should allow. And the more intrusive it is, the more we should be nervous of its application.

Why the impulse to centralize everything?

In the past families would look after their own disabled members. Of course this is easier in large non-nuclear families. But maybe something like more like community centers in every town rather than imposing "Insane Asylums" run by scary officials would help?

To be clear, by institutions I don't mean monolithic asylums. I mean institutions in a broad sense. The way the fire department is an institution. I mean something much more akin to networks of social and the community centers you mention.

It might be worth considering that when the problem is "How do we help the mentally ill and destitute among us?" and the answer is "Fundamentally reformulate how Americans relate to their government", some might see a measure of disconnection between the two. Certainly it's a big ask that offers little in the way of obvious gradual steps.

Yes. This is the problem and probably why we are doomed to repeat this cycle of tolerance and crackdown.

> Medical ethics and legal protections have come a long way since then. You wouldn't see doctors straight up experimenting on people at least not with legal sanction and the state now has an obligation to provide people attorneys. So using your own lawyer to get aunt Elsa committed while she just at the mercy of the system wouldn't be so easy.

I completely disagree as a person who suffered involuntary treatment for 2 months and was drugged against my will for a psychological disease I didn't suffer. I'm a transgender woman that was going to university getting bullied constantly. One day it turned into an incident where the bullies fabricated a story to campus police and where my account of the situation wasn't listened to. Anyhow, I ended up with a psychiatrist that didn't ever treat gender dysphoria but believed it just has to be schizophrenia. They billed my insurance provider $58k USD. Needless to say, I also don't pass as a woman because of the religious abuse in that community and with unaccepting parents. I've never been able to save 58k to pay for surgeries unrighteously classified as cosmetic towards the illness gender dysphoria. Anyway, I tried to find legal representation for the wrongs and nobody in any civil rights institution for victims would help.

While I generally agree with your points, I think that its a little strange to sum this up as a "really simple problem" and then declare the solution to be building institutions to specializer in the assistance and care of people with a wide variety of issues.

That isn't "simple" at all.

True.

The diagnosis is simple. We have a cycle of sympathizing and then cracking down on marginalized people and it stems from having a one size fits all approach to social problems.

The solution of course is terribly complex. It stresses some of the most difficult questions of Western social philosophy. Such as how much should we respect the individual will vs. the collective need? And what is our obligation to the needy? And how much power over others should we place in the system or delegate to people?

It's not a simple problem, as many of the posts in this thread indicate. If it were simple, it would be easy to solve. But there's a lot of factors at play. One of them is that the United States is big, really big. If you've never visited, you'll be amazed at how big it really is. And it's a lot more atomized than it used to be 30 years ago. Add to that the fact that rural areas are drying up, and more and more people are moving to urban centres.

Another is zoning and NIMBYism. Others here have explained this in detail far better than I could. But to put it simply, most of the public services that homeless and mentally ill people depend on are located in urban areas. When people say things like, "there's plenty of cheap housing in ____" they don't understand that no matter how much oversupply of affordable housing there is in that place, these people can't live there because they don't drive, there's no public transportation, and there's no clinics there.

This was the most frustrating thing for me reading this, how the issue has become artificially dichotomized. There's obvious solutions that don't involve criminalizing but also recognize mental illness as such. It's almost a made-up problem in the sense that there's an obvious type of solution that seems to be ignored in public discussions.

To your point:

Seattle and King County judges have been bringing social services to the court house, to better serve their clients. Our courts see the consequences of our inadequate safety net first hand.

While innovative, these reforms are far from ideal or adequate. But the judges feel they have no other choice than to try to fill the void.

The article mentions those mental health facilities were shut down in the 1980s.

I guess you mean some better modern version of them deserves more funding?

Yes but what I really mean is that if people are in crisis we've already failed. We have to create support networks that keep people out of crisis.

Lifting people out of crisis is tremendously difficult and I actually don't know how we deal with the number of people we have in crisis now.

This comment is really missing the point about zoning and housing, which the comment right below it really gets: https://news.ycombinator.com/reply?id=20422459&goto=item%3Fi...

A housing network or authority is one of the first institutions we should build up. Housing first is probably one of the best thing we can do to fix this.

And yes such an institution would be totally hamstrung if we don't address costs through zoning and permit reform.

The criminal justice system only handles these things because there's laws on the books saying they can. Busybodies have managed to convince politicians to criminalize basically everything.

The reason people keep looking to law enforcement to solve these problems is because they can. Take away that and institutions (government or otherwise) will eventually spring up to solve the problem. Visible homelessness running rampant in the time it takes for that to happen is simply the penalty communities will have to suffer for being so economically dysfunctional as to have the problem in the first place. This is the phase some west coast cities are in now and of course there's some backlash and people who want to go back to strict law enforcement.

As long as someone acting on behalf of the government can tell a homeless person to move along from a public space the problem will not go away. It will just move to the next street over for a few hours then come back when it gets kicked out of there too. These people need either better options that are so much better they take advantage of them (i.e.) better shelters or to be institutionalized against their will and I don't think the latter is compatible with our values.

I agree. A lot of this problem stems from the deiinstitutionalization of American life in the middle of the century. Which generally was a right minded and compassionately motivated thing to do. And I agree that cities which see this as a real problem should begin building the proper administrations and institutions to deal with this. But usually when cities begin to see this as a problem, they don't do that. They revert to using the only tool they have at the ready. And they bring the hammer down harder than they ever did before any relaxation of its use.

> right minded and compassionately motivated

Don't confuse the two. Breaking down a working system that was evil without creating a replacement, without gradual transition, can (and did) result in a more evil system.

They were motivated by compassion but not right minded.

> A lot of this problem stems from the deiinstitutionalization of American life in the middle of the century.

This was true thirty years ago, but is much less true today. The fraction of people that have serious mental illness is relatively constant, but the number of visible homeless people on the street has risen dramatically. What you're seeing today is a fraction of mentally ill people and then a larger fraction of drug addicted people stemming from the opioid crisis.

It's not the 80s anymore and that person screaming to no one on the street corner is more likely to be in meth psychosis than schizophrenic.

I don't think the two groups are so easily distinguished. And I think you underestimate the effect of housing pressure on people already on the margin.

Yes, I agree housing prices also affect a large number of people, but I think those are mostly the invisible homeless — ones who can scrape by couch surfing, living out of their car, etc. What I'm referring to are the visible homeless — the ones on the street harrassing people, dumping trashing, etc. I think most of those today are there because of drug addiction, with a smaller fraction because of mental illness. (And, of course, illness and addiction often overlap too.)

The reason I point these out is because I think the different groups need different solutions. Affordable housing isn't going to do anything good for something in the middle of meth psychosis. They'll just trash the place which is a complete waste of funding.