California proposal would force unhoused people into treatment
theguardian.com
theguardian.com
When he went off the rails, the authorities absolutely refused to do anything, even after he started talking about shooting up a local synagogue.
We eventually got him care, but only after he was fired, divorced, homeless and went from $100,000s in savings to $100,000s in debt. (The spending was on non-medical things. He had health insurance at the beginning of this, but eventually stopped paying for it).
The healthcare workers said this was pretty much the best case outcome because of current law.
There are a lot of drug addicts in homeless encampments, and they are often a menace to other people and to themselves (the drug addiction often going hand-in-hand with mental illness.)
Many homeless already have problems with banks, the criminal justice, healthcare system and other institutions. This is just going to add an extra institutional problem keeping them trapped in homelessness.
Right now, we operate under the ridiculous presumption that members of the (b) group are capable of acting rationally and in their own best interests. This is objectively false, but since this is the presumption we are forced to pretend is true, we can't force them to into treatment, however bad they may need it, unless they are at risk of inflicting imminent physical harm to themselves or others (but in this context, physical harm doesn't mean any harm typically arising from drug use...)
The proposal lets us force the members of the (b) group into treatment/rehab, however much they may refuse. And this is important, because people who are mentally ill will refuse treatment, until they get treated, at which point they recognize why they need to be treated, and will generally choose* to remain under treatment and to accept housing.
We should take care not to assume that everyone in the "permanently homeless" category is there because of some sort of mental illness or drug addiction, forcing them into unwanted and unnecessary "treatment" until they agree to conform. Not wanting to be housed is not, in itself, a mental illness.
IMHO the only thing that could potentially justify forcing someone to accept treatment (or confinement—their choice) would be if they are manifestly a danger to others. In other words, the current situation without this proposal, except no use of force is justified against those considered a danger only to themselves and not others.
I am a 'live and let live' person and generally not bothered by the sight of homeless people (besides sympathy for their plight), but it has all started to get out of hand in California.
https://everyonehome.org/wp-content/uploads/2019/07/2019_HIR...
Nationally the percentage range from 60-80% of chronically homeless as mentally ill depending on the study.
If you prefer to blame homelessness on mental illness, you need some kind of explanation for why homelessness has tripled in ten years, and why it's highly correlated with rents and anticorrelated with vacancy rates.
80% of the homeless recover. It's mainly the mentally ill ones that stay chronic.
No, that was the ACLU and the courts.
https://www.kqed.org/news/11209729/did-the-emptying-of-menta...
https://en.wikipedia.org/wiki/Mental_Health_Systems_Act_of_1...
[1] https://www.npr.org/sections/money/2021/06/08/1003982733/squ...
There are several more papers that back the mental health angle. The key issue in the United States is that we need to have the consent of a mentally unwell individual before we can give them the psychiatric help that’s needed to get them off the streets
From what you linked: "A qualitative study highlighted the basic human needs that often take priority over seeking psychiatric care. Access to adequate nutrition, water, shelter, and protection from the elements are the reality homeless individuals encounter daily, and these issues take priority over psychiatric needs, which are often not addressed until a crisis occurs."
Forcing the homeless into psychiatric care without their consent is skirting around why psychiatric care is currently inaccessible. People die rationing insulin, something tells me Uncle Sam isn't going to provide bipolar people on the street with free lithium. Plus people have good reason to distrust their doctor, a non-zero portion of homeless people ended up there after being prescribed Oxy and getting addicted to opiates. Substance abuse is driving most of the disparate health outcomes, and is a mental health issue but more importantly a public health one. The US as evidenced by the lack of a pandemic response does not care much about the public health.
I have good insurance. And supportive parents. I found navigating my diagnosis and care difficult, and I don't live on the street. I feel as though some of the commentators here have never experienced poverty nor can they empathize at a basic level with the struggle. It just seems as though psychiatric wards are meant to disappear these people since we can't disappear the underlying problem: commodification of shelter, water, food, knowledge.
As a former homeless person myself and not someone from an upper middle class background, being more proactive with the mentally ill makes total sense.
Btw chronically homeless people tend to experience schizophrenia more often than ADHD. It’s much easier to be high functioning with ADHD compared to the mental illnesses that the homeless tend to deal with
The voluntary aspect of this plan seems to be incredibly foolish to me, and I suspect it will not be accepted at high rates.
Here's to hoping it helps anyway, even if I am not so hopeful myself.
That said, I don't particularly want to be involuntarily committed either — it's a frightening thought, especially for those who have been involved in the justice system, where basically nobody cares about you as an individual. You'd want to have some kind of public awareness campaign so people (including potential patients) can see that they're not the asylums of years past. Play up the "spend the day playing checkers in the day room and getting better" part, play down the part where they don't get to leave until the nice people running the place decide enough progress has been made.
Getting back to inmates, I spent some time reading feedback form entries about how various inmates felt about their new tablets. I took an excerpt from one and sent it to a couple of product managers — the guy had written up his test cases and findings so professionally they were sure it had come from one our our QA teams. I guess we know what he did on the outside... One of the more paranoid inmates ranted about how his tablet was watching him, tracking his movements, etc., but then complimented us on the selection of movies — I guess I know why he briefly overcame his paranoia and accepted the tablet (they're not mandatory).
As long as the "don't get to leave" part remains true your "public awareness campaign" sounds a lot like propaganda to me. This sort of thing is why people don't trust the system. You need to be up front about the restrictions, and persuade people (especially the prospective patients) that it's worthwhile anyway.
That's pretty much what I saw when I lived in, and traveled to CA.
IMO: A major contributor to homelessness in CA is the absurd cost of living.
I live in California and I recently tried to help a friend get mental health treatment. We were refused because they were already at capacity and simply couldn't take on any more people. They even admitted she obviously needed help, but there was nothing they could do.
The obvious solution is to increase funding for public mental health services so they actually have enough resources to help people in need. At the moment, people who want treatment can't even get it, so it's very confusing when the state seems to think forcing treatment upon homeless people and undermining fundamental human rights is some kind of "solution".
It doesn't seem hard to imagine someone living on the street/in their car in the Bay Area and not having housing, but having a job and feeling trapped. That trapped feeling makes them not quit the job or move to another area, for fear of being in a worse position. I worry there are more people in this type situation than we know. I wouldn't want people like this to be put into an institution.
What if someone doesn’t want help? We shouldn’t be forcing anyone to do anything.
I don’t care. You can’t live in the park. That’s not a valid lifestyle choice.
We should expand systems to prevent homelessness in the first place but once that point is reached “no thanks” is no longer an acceptable response to offers for help.
> that point is reached “no thanks” is no longer an acceptable response to offers for help.
On this path lies a terrifying dystopia. For example, I find smoking and eating ultra-processed food an incredibly invalid lifestyle choice; doctors agree with me. Should we also mandate forced smoking addiction treatment and diet watching?
Leaving the extremely mentally ill/drug addicts to essentially rot and die on the street is not a solution for anyone. I'm not saying all homeless people fall into this category, but this is the segment that is driving this change.
Try eating a sandwich for lunch in Pioneer Square, or in Denny Park.
That I don't feel safe traveling through my own city because it is overrun by mentally unstable people is unacceptable. Neither they nor I should live like this.
We have rules and norms in a civilization. When we ignore real problems like mental health everyone suffers and those norms break down. I am not in favor of adjusting our norms to include "well you can't use public spaces because we don't care about mental health".
I feel like the homeless issue is a case of two sides talking past each other. Homeless advocates (and the "industry") are doing their best to support the "down on their luck" individuals. These folks are capable of holding down a job (maybe with some support), but might struggle to afford rent. The "homeless industry" is heavily focused on helping them. Meanwhile, local residents are complaining about the decline in quality of life from having individuals with drug and mental health issues living on their doorsteps. These types of homeless are very resistant to the services provided by the traditional "homeless industry". When you see a significant amount of tax revenue going to homeless services, but the guy living in a tent down the street is getting no help, it can be very frustrating. Hopefully this measure is the first step towards solving that issue.
Including resorting to $60K per year tents. [1]
But we could steelman the argument for proposals like this one: you could see homelessness as a problem of loneliness, addiction, mental health issues and unstable families. This might be more realistic compared to seeing it as merely a housing issue.
[1]: https://www.sfchronicle.com/politics/article/S-F-officials-w...
the issue is more that the landowner/rentier class are still the most politically vocal, and anything that upsets the status quo for them gets an insane amount of pushback.
Homelessness (particularly voluntary) is an existential threat to capitalism because it reduces the productivity of the working class. This in turn diminishes the gains of the proletariat, who need workers and purchasers of their goods and services (such as houses).
The title story seems like a scary way for the system to force people into becoming productive members of society. In the system's eyes, these people are useless, unwanted wastes of space, so they are going to force them into treatment so they can "lead normal lives," a euphemism for turning them into productive cogs in the proletariat's capitalist machine.
This isn't an American problem. This isn't even a liberal/conservative problem. This is a west coast problem.
It seems to me that all 'temperate' locations, do have a huge homeless issue, Summer in Texas is enough to drive the homeless away.
The entire European Mediterranean region has similar weather to the Western US and doesn't have the same homelessness issue. Lake Tahoe, Chicago, NYC, Vancouver hit freezing in the winter and do have homelessness.
I think it's easier to permit homelessness when people don't freeze to death or become heat casualties, but the causes are way more complex than the weather being nice year round.
Population density matters when talking about the visibility of homeless people, even before getting to how stupidly expensive those places are.
I'm in Massachusetts now, and as a west-east transplant I'm amazed at the stuff that just works. Cycle paths get built, housing gets built, state social and health services are extant and useful. I'm sort of at a loss to explain the difference.
perhaps the same reason that it's really hard for me to view SF as a "real city" after living in NY for a few years. Even with all the money moving around in the bay area, so little of it actually makes its way back to the built environment.
https://ceq.doe.gov/laws-regulations/states.html
The fact that CEQA applies to all levels of government in California makes it easier to throw sand in the gears.
Similarly there is too much good government sometimes, too much accountability makes it hard to accomplish anything. Too little means corruption is hard to root out. There is less accountability in the east overall in bureaucracy - any state not hit hard by the progressive revolution of the early 20th century seems to be better at doing thing.
I see more community focused expectations of behavior on the east coast (There is more of an expectation that everyone ought to behave a certain way, and do certain things in certain places).
There are other cultural differences too, east coast residents in my first hand experience tend to be more apt look the other way at penny ante corruption (the stereotypical "I know a guy.." culture), which somewhat perversely makes government more flexible work better. Generally the less moral imperative government has, the better it works.
I realize these are probably not popular opinions.
https://www.theguardian.com/us-news/ng-interactive/2017/dec/...
A better solution is to provide them with shelter, community, mental help, education, and generally good care. This is actually even harder to do than just throwing houses at them.
But there is also merit to giving housing to people who are homeless but not mentally ill. Many European countries do this.
I don't see a problem with that. Sure it's trashy and sure I'd appreciate it if I didn't have to pay for it but a) the alternative is drugs on the sidewalk b) who am I to tell others how to live?
You can't build a new million dollar home every 5 years for addicts.
If you're proposing giving people free rent, food, and utilities indefinitely, that starts to get uncomfortable as it edges toward slavery.
This isn't true, why does it get repeated so often.
Was this just something you've heard before and didn't double check before posting it?
Usually, when people refer to homelessness, they are talking about the people living on park benches and pushing around shopping carts or sleeping off their last high sprawled out on the sidewalk. Most of these people need mental health care. Not just a home.
I support this proposal 100%.
It will not solve the housing crisis in California, because it's largely driven by high prices. But it will help us restore basic decency in our treatment of fellow citizens who badly need help.
Also, that approach forces law abiding citizens to first earn a criminal record before obtaining medical care.
Yes, this approach would result in criminals receiving criminal records.
I have worked in housing units filled with mentally ill inmates and as one might imagine it's not a therapeutic environment (though at least they are somewhat shielded from predation by the general population).
I don't see how this parallel judicial system of "care courts" will be able to do anything that the existing judicial courts cant.
Either approach will require rehabilitation centers that work, and the existing courts could send someone there just as easily as this new court.
Diversion is actually the preferred process for first-time (non-dealing) drug offenders. However, repeat offenders are not entitled to diversion, and due to capacity constraints, must generally surrender their spot to first-time drug offenders (the best analogy I can think of is Disney's Lightning Lanes vs Standby Lines), because first-time offenders are more likely to benefit from diversion than a repeat offender for whom diversion clearly did not work.
There are simply too many drug users for the rehab programs to handle. It's not a matter of just increasing the budget for rehab, because more than half of the drug-related offenders are repeat offenders who have already gone through rehab and relapsed.
If an addict or mentally ill person is repeatedly harming others or breaking laws, the only solutions are rehabilitation or incarceration. The problem is that we are failing to rehabilitate and following that, we are failing to incarcerate.
I don't see how a parallel judicial system of "care courts" solves this fundamental problem.
If an addict or mentally ill person is repeatedly harming others..., the only solutions are rehabilitation or incarceration. The problem is that we are failing to rehabilitate and following that, we are failing to incarcerate.
Non-violent addicts are eligible for diversion, which means a separate judicial process that includes rehab. But only first-time drug offenders are entitled to diversion in lieu of incarceration. A person cannot be forced to rehabilitate: they must choose to rehabilitate. If rehab fails, it is because the addict has failed, not the system.
Violent offenders are generally not eligible for bail, and are not eligible for alternative sentencing options like diversion, home detention, half-way housing, or early release. They are simply incarcerated in jail, prison, or a mental hospital. We are definitely are not failing to incarcerate these individuals...once they commit violent crimes. The problem is that we simply can't incarcerate them until they commit a violent crime because homeless rights advocates have convinced judges that these types of individuals shouldn't be incarcerated because their too mentally ill to understand what they did is wrong. (Yes, the very thing that makes them more dangerous is also the grounds for not doing anything about it until someone else gets seriously hurt.)
Addicts (even violent offenders) can participate in rehab in prison. If they are eligible for it, want it, and there is space in their local facility's program. They cannot be forced to participate in rehab.
Mentally ill individuals who cause harm go through the process of "civil commitment" whereby they are committed to a mental hospital for treatment and remain for at least the duration of the prison sentence they would have served for the crime if not mentally ill. Depending on the extent of their illness, and the role it played in their violent actions, they may remain committed for significantly longer than they would have if they had served time in jail (and may even remain committed indefinitely).
I don't see how this system of "care courts" is doing anything new that the existing court system cant or dont.
It seems to propose doing the exact same thing we already do in courts, but under a new name and hopes for a different outcome.
Can you explain how it will be different?
If their mental illness or addiction is harming others, they should be rehabilitated
>A much better solution is simply to enforce laws on the books and set up jails and prisons to do actual rehabilitation
Instead of charging them with a crime in a real court, and mandating rehab programs or incarceration if they don't cooperate, we will charge them in a "care court" and mandate rehab programs or incarceration.
Seems like the same exact thing.