American Emergency Rooms Confront a Crisis of Violence
city-journal.org
city-journal.org
'...When I sit down with Desaulniers, he's tired and stressed and the deep creases between his brow are furrowed.
In our brief meeting, I get an up-close look at how much he's juggling by the number of people who approach him as we're talking at one of the tables in the grocery store's cafe.
For starters, there's the worker who has arrived to fix the $4,000 broken window due to a robbery early that morning. There's also an investigator from the District Attorney's office who drops by to share that a customer who bit Desaulniers in the arm is being subpoenaed (This is the second customer who bit him). And there's the employee who asks him to deal with an uncontrollable customer who is shoplifting and hollering that he needs to use the bathroom'.
https://www.sfgate.com/bayarea/article/SoMa-San-Francisco-Ha...
This was the early 20th century solution to homeless crazies. Was it better than what we have now?
[1] https://en.wikipedia.org/wiki/Agnews_Developmental_Center
There is a lot of hidden history in Silicon Valley.
Another (computer oriented) one can be found reading "The Secret History of Silicon Valley" https://steveblank.com
I grew up in South East Asia, where I and my friends were taught to pretty much revere the people in this line of work. I guess it is still that way in those countries too, highlighted by a recent video of the protests in Hong Kong where huge crowds of protesters would willingly make way for ambulances to get to casualties in the crowd.
Is it something that we need to ingrain to our kids as they are growing up, so that they have more empathy? It astounds me that a paramedic friend of mine was recently kicked and punched by 2 "friends" of an unconscious person as she tried to save his life on the street. She says it is a really common thing nowadays. Where is your mindset at when you try to prevent someone from saving your friend's life?
Why is our society so tolerant of this? Why should anyone, let alone an educated, working professional have to put up with this?
We should strive to have compassion for the homeless and ill, not imprison them.
It's a nice thought, and should probably be an option, but it won't be sufficient on its own, I don't think.
Would it surprise you to learn that many with severe mental illnesses do not voluntarily undergo treatment? A friend worked in a job training and support program, first with chronically homeless, and then with mentally disabled specifically. The single biggest obstacle most faced was their own unwillingness to accept or stick with treatment.
The homeless in particular that this friend worked with were untrusting of any program that might potentially hinder their autonomy- so they would show up for the free bus cards, food and job training, but any hint of medical support and they would disappear for fear of being taken off the street and locked up.
Most, given the choice between jail or treatment, would choose jail, simply because there was a defined time period that they would get their freedom back, plus no pills.
It can be dangerous to give governments carte blanche to do this...
> Sluggish schizophrenia or slow progressive schizophrenia was a diagnostic category used in the Soviet Union to describe what was claimed to be a form of schizophrenia characterized by a slowly progressive course; it was diagnosed even in patients who showed no symptoms of schizophrenia or other psychotic disorders, on the assumption that these symptoms would appear later. The diagnosis has long been discredited because of its scientific inadequacy and its use as a means of confining dissenters. It is considered a prime example of the political abuse of psychiatry in the Soviet Union.
You prosecute someone that's mentally ill and send them to jail. Now the jail has to deal with violent outbursts and is generally not equipped to handle people on a medical level like that. Our prison system is designed to punish people, so those people if they get out of jail fall back into the same issues.
The answer to solve these problems is better preventative care. Meaning better healthcare for vulnerable populations, better solutions to housing for the homeless and so forth. Unfortunately solutions like this require things like increased taxes or recognizing the problem exists and many would prefer to just sweep it under the rug for people in emergency rooms and jails to deal with.
None of this discussion solves the actual problem at hand, it just deals with the symptoms. Eventually the problem will become uncontrollable if you just ignore the actual damn reasons why people with said issues end up becoming homeless or violent in the first place.
We can and should chip away at risk factors, but the human brain is wickedly complex and we're never going to get 100% health and behavior within norms. Just like we can and should encourage exercise and healthy diets, but we're still going to need the medical system.
Truly a good solution. /s
Check out some rural newspapers for these type of police briefs or court news.
However, imprisoning the mentally ill carries its own set of issues.
https://www.npr.org/sections/health-shots/2018/04/25/6056661...
The US generally has severe enough punishments, and increases do little to add deterrence (and the downsides then take over).
Certainty and speed are weak though. People drive in a civilised manner because if you don't, a cop will write you out a ticket. But if people behave in an uncivilised manner in a more criminal way, it's actually unconstitutional to have swift and certain penalties.
People are fine arguing that the 2nd amendment was more appropriate for the era of muskets. Maybe the 5th is more appropriate for an era where overly harsh sentences were applied to political prisoners through the use of torture.
Ban those people from emergency services.
A sick society is one that cannot handle minor disagreements.
Whenever I think of rights, it is things that society and other people must not do, rather than something that other people must provide for me.
And whatever valor is, nobody agrees exactly. Building a society on such nebulous things is a great way to end up with some kind of extremist -ism.
You don’t get to extremism from tolerance and diversity. Acceptance of minor disagreements is a good thing.
However, most people who consume emergency services, don't do so unconscious. Hospitals, EMS, etc. want to get paid, so you're going to be asked for an ID sooner than later.
Some people might not want to give ID, or just not have it on them. I don't know what hospitals do in this case currently, but it doesn't seem like a huge stretch to just make those people give fingerprints to continue treatment.
This[1] claims that 4 finger IDs from fingerprints are 99.9% accurate, which isn't perfect, but it's pretty good.
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1. https://www.nist.gov/news-events/news/2004/07/nist-study-sho...
I live in a country with universal healthcare. When I get sick or have an accident that requires urgent medical treatment, I'm wasting literally zero thought on "Can I actually afford this?", I just get the help I need and it won't leave me with massive debt.
I can't even imagine how depressing, and for some probably enraging, it must be to be in a situation of distress and pain, while having to consider if one can actually afford to get professional help, without having to pay off crushing debt for the rest of one's life.
The surprise here is how few people snap from this very apparent inhumanity going on.
If nothing else, it should be clear that the behavior will result in immediate corrective action. If it’s not, then there’s no deterrent at all.
"declining communities must respond to drug abuse, homelessness, and antisocial behavior"
A significant cause of drug abuse is chronic untreated pain, another significant cause is addiction CAUSED by medical treatment (the so-called opioid crisis), and of course neither homelessness nor antisocial behavior are even remotely mental problems. In short, VERY few of these people have mental illnesses other than being poor.
In other words what this article is complaining about are ... economic problems that cause people to become more desperate, less willing to compromise and all of those economic problems must of course be mental illnesses. Futurama put it best:
https://getyarn.io/yarn-clip/ec2178ed-acf0-4aab-9141-2c17d11...
All of this of course means that the vast majority of "mentally ill" do not have any problem responding rationally. Their rational responses are simply not what the clinic and/or other people want to see. For example panicked responses to not receiving treatment for a child because they have no alternative. The article reports that ERs let some people wait for weeks before any actual medical care was provided, then complain these people protest, and at some point protest strongly, even violently.
It is not "mental illness" that makes people unwilling to accept this, and it is not irrational. And, of course, there is a point where people decide violence is more likely to get them somewhere than acting nice. That, too, is not irrational.
If a doctor refused care for your daughter who, say, has an epileptic seizure. How long would you accept waiting in an emergency room before you would start shouting? How long before you'd turn violent?
Because in all honesty, it wouldn't be weeks.
The solution is better medical care, and LESS mental health "help", of course.
Some other countries have similar problems and yet others have little or no trouble. In the long run the social conditions that cause the violence have to addressed, adding security protects people in the moment but does not fix the root cause.
I realize that this is cold comfort to those affected right now.
It's sad that we need bouncers for the ER, but here we are.
https://www.beckershospitalreview.com/finance/7-things-to-kn...
https://www.commonwealthfund.org/publications/newsletter-art...
With little motivation to staff up, this seems like the predictable outcome.
This article calls out people with mental health or drug addiciton specifically.
"As doctors and nurses administer care, they risk physical assaults from drug-addicted or emotionally disturbed persons"
There are plenty of legitimate reasons that would make sense for a person to wait an hour or so in an ER once they have been stablised/triaged, such a for observation, further diagnostic tests, or the attention of a particular specialist.
An otherwise-healthy person can generally deal with this without getting violent, even if they're feeling a bit stressed, but if someone's tripping balls and being chased by robotic dinosaurs, then it's no wonder that people are acting out and behaving in ways that transgress social norms.
Color me completely unsympathetic.
Right now I am dealing with fantasy bills from an ER visit a few months ago.
The whole medical-industrial complex can die right now. I have no sympathies for anyone in it. If they get assaulted in the course of work, they earned it many times over.
A couple of years ago I fell for the high-complexity drug testing scam at the intake visit. It goes like this: you pee in a jar, and they send it to an out-of-network lab. A few weeks later the 4.5 kUSD bill arrives, which isn't covered by insurance. Everyone denies responsibility: the physician says you gave us the sample, the insurance says out-of-network, and the lab says services rendered. The charges eventually went away, after several afternoons on the phone.
Civil society offers no solution. It's no surprise that people give way to their anger. There isn't even a contradiction.
So you may want to direct that lack of sympathy towards people who created the system as it exists now instead of those working in it.
There's also a big difference in required skills between doctors, fire fighters, and social workers.
Full stop doctors are profiting off the sickness and suffering of others, when they take an oath to do no harm.
Yes, I agree, the Doctors Without Borders people are saints (no sarcasm here - there are truly good people in this world). That is not the rule in the US - the rule is that we have greedy evil people who are making money off of cruelty.
Sure, the pay is very high, and they could live a good life with less. But it's not the biggest expense in the system overall - ie it doesn't really impact your bill that much. Other countries also have high doctor pay and don't suffer the same issues with healthcare billing, so concentrating your anger on people who actually do the work to help you is a bit misguided.
I just disagree with you.
It isn't doctors that deny US Americans a proper healthcare system instead of a "health business".
Those decisions are made way higher up on the political level, that's where you need to vent your frustrations.