It's Time to Mandate Treatment of the Dangerously Mentally Ill | Hacker News Reader

It's Time to Mandate Treatment of the Dangerously Mentally Ill

commonsense.news

47 pointslxm136 comments

> What’s needed is a single agency, let’s call it “New York Psych,” to address this growing crisis

That... doesn't sound like a great idea. If you're all-knowing and all-good, great. Otherwise seems like a pretty gross violation of basic human rights - what about the false positives (people who get forced treatment while claiming that they are not ill and don't need it and then that turns out to be actually true).

We could temporarily solve many of the world's problems if we had more authoritarianism, but it never ends well in fiction or in real life.

Once the side effects of the medications kick in nobody will ever find out they didn't need them.

I mean, you could say the same thing about jail sentences right? Presumably this forced treatment would be done via due process. Maybe in cases where a medical sentence is issued, half the jury are psychiatrists or neurologists or have some appropriate qualification.

To be clear, are you saying people who commit crimes should (in some cases) face forced treatment. OR. That mental illness itself should mean forced treatment?

Sentencing someone to a secure hospital rather than a prison for crimes is one thing. Sentencing them for not fitting in is another.

Sorry if I have misunderstood

The case I was thinking about is something like, let's say there's a obviously mentally ill guy thratening to kill people. I'm talking hobo smeared with shit, reeking like all hell, tattered clothes, broken bottle in hand, screaming obscenities and frightening people with death threats in parking lots. You know, regulard tuesday evening in LA.

I think the police should be allowed to arrest this man. A DA might decide to file this new mental health charge against him. Assuming the crazy person doesn't accept the plea deal he would be offered, voluntary commitment in a mental health facility, this goes to trial. If the trial finds the defendant guilty of being insane, he is forcefully commited to said mental health facilty.

Are there issues? Sure. Is it somewhat ok because it's done via due process? Maybe. Is it better then letting potentially violent crazies in desperate need of mental health treatment run loose? Absolutely.

You can already be arrested for the things your describing, they're crimes. And if the judge feels it's appropriate sent to hospital. If that isn't happening it's because cities (understandably) cannot pay for the enforcement or treatment. I don't think we need any change in the law for this.

The due process necessary to put someone in prison is generally far more rigorous and affords the accused more rights than the due process necessary to institutionalize someone.

It's possible to construct a system that respects the rights of the mental health patient, but we have historically not been able to do so.

Before the 80s, we'd just throw people into madhouses and toss away the key. That system, and its myriad of abuses was torn down due to public backlash, and was replaced with... Nothing.

Your third paragraph seems to contradict the first paragraph. If there is no system to institutionalize people, then how can it be less rigorous than the system to imprison people.

Are you suggesting there hasn't been any involuntary psychiatric in-patient treatment since the 1980s?

There probably is, but as I understand, there are some Supreme Court rulings from 1970s to 1990s that make it very costly and/or require a high bar of proof that accused is a threat to themself or others.

The workaround to the very high costs of working within these rulings was imprisoning people for drug or other non violent offenses, which was much cheaper and easier.

There still is a system to institutionalize people that haven't been breaking any laws, but it's very short-term. If you're interested in checking it out, a failed suicide attempt can give you a peek into it. They are unlikely to keep you for very long, though.

The long-term system was largely shut down in the 80s, because of the aforementioned abuses. The bar to get someone thrown in the loonie bin was very low, and once you're there, good luck proving that you're sane, or that you're being abused and mistreated.

> There still is a system to institutionalize people

why are we talking of "institutionalizing" people? Compulsory treatment of someone experiencing an episode involves depriving them of liberty, while staff ensure they take their drugs, and doctors monitor their effects. Institutionalization generally means that you've been incarcerated so long that the institution is now your home, and it would be a struggle to live back in the world. Institutionalization was a large part of the problem with the old asylums.

At least one mentally-ill person I've known had been taken off the street several times; she was bitterly critical of the abolition of the psychiatric hospitals.

See my comment regarding 18 U.S. Code § 3553(a)(2)(D). Due process is superseded by 'treatment in the most effective manner' under Federal law, including losing your Constitutional right to be sentenced by a judge (a treatment provider, not a judge, determines the rules of your Court Ordered treatment imposed with the full force of the Federal Government).

> what about the false positives (people who get forced treatment while claiming that they are not ill and don't need it and then that turns out to be actually true).

We have a criminal system even though the exact same is true in some crimes.

You have a judicial system in place to prevent these false positives.

I dont understand. Can you explain that?

In the context of this comment thread:

False positives = someone wrongly accused of a crime by the police.

After the accusation follows a trial (this is the judicial system) where the wrongly accused can prove that they in fact did not commit the crime.

Thus judicial system is setup to deal with the false positives.

That doesn't prevent the false positives, just cuts the process off before prision. And studies show that 2-10% of the incarcerated are wrongly convicted or completely innocent. Also, involuntary commitment could be a civil law which does not carry with it the same protections as criminal law, depending on how it's defined. So I'm still not seeing how this prevents false positives.

I think you have a different threshold for the word "prevent". Which is fine by me.

It sound like maybe you mean reduce, not prevent.

Yeah, but there you come out the other end with your mind intact. These forcibly prescribed treatments have side effects that can do irreversible damage. Can't get that appeal hearing if you can't think straight anymore.

Highly debatable that regular prison leaves your mind intact.

Very true. Although the scope is quite different between the conditioning you face in a prison and the chemical alteration of various medications. Generally, one can be resisted or controlled, whole the other cannot.

Agreed, it's basically the same argument as against the death penalty. Can't exonerate yourself if you're dead, can't be found mentally sound if you've been effectively lobotomized.

Obviously psychiatry has come a long way since lobotomy, but it doesn't have a great history when it comes to treating unwilling patients.

If a mentally unwell person is a demonstrated threat (ie commits crimes and harms/endangers people) the state already has the power to lock them up. In my view letting the state forcibly alter their brain and mind against their will is a bridge too far.

> In my view letting the state forcibly alter their brain and mind against their will is a bridge too far.

I don't share your view. It's quite clear to me that there are circumstances when a mentally-ill person benefits enormously from compulsory treatment (provided they are released; a system that rewards clinics financially for continuing to detain patients that are fit for release is a special kind of madness).

The justice system has nontrivial checks on the power of the state to incarcerate people and it already has massive problems, what would a system without those checks do?

Probably similar things as the civil law parts. See the flagrant abuses of things like restraining orders and red flag laws in divorces, or civil asset forfeiture, etc.

I will say this, I grew up in a time of asylums and I lived thru their gutting of them with the Reagan administration and back then law enforcement was very different it did not become militarized until the LA bank shootout and some other events in the same timeframe. To say it was a different world would be an understatement. In that world false positives where rare, usually there was a history of issue as well as close family that agreed that it was for their good.

Nowadays law enforcement does not know your name, they suspect you from first contact and family is not as tight knit as it was. I would be very leery of asylums in present society, due to the many ways in which society has changed.

This is true.

Many problems were solved by authoritarianism, if by problem you mean people being alive.

I agree it doesn’t sound like a great idea, but someones rights are going to be violated either way. Either we forcibly admit people who appear to need it (with the false positive that come with) or we continue to violate the rights of the public to not be constantly harassed and assaulted by these people.

Don’t live in a city so poorly run that it has a large homeless problem. Not only am I not constantly harassed or assaulted by mentally I’ll people, but I have NEVER been harassed or assaulted by a mentally ill person.

How does this even make sense? What are you even saying here? Everyone just leave your city until you find one that's automagically well run? Surely you must understand that this conversation is abut ideas to better run a city. But you're saying nah, just leave instead! I'm sure Boise Idaho will be happy to have you!

It doesn’t make sense. They either dont live in an actual city, or they live in a city “without a problem” because they are bussing their homeless to California. Super convenient way to deal with it.

It is the only thing that makes sense on an individual level absent legislation and funding from the federal government, because of the lack of immigration controls.

I lived in Boise for years and spent time volunteering at the Boise Rescue Mission. You are right, Boise will be happy to have you (it's a very welcoming city). But, there are people in Boise who need help. Go Broncos

Ah, I should have been more careful then. I was under the impression that Boise was dealing with an overwhelming transplant issue and was resistant the way Austin and Portland have been.

I thought this site loved the free market - guess there needs to be a new forum to regularly check.

Well, I mean NY has a general inclination towards being overly restrictive based on psychological tests. So I guess it makes sense to start it there.

I believe a big story a few years ago was how they stripped a retired cop of his gun license over his admission that he was "sometimes blue" even though there was no indication that he would be dangerous to himself or others.

Very much agree. We'd need a very clear definition on what dangerous is before something like this is considered. Some now consider speech dangerous. An authoritarian government may choose to consider those who disagree with policy to be dangerously mentally ill. I mean, only crazies think like that, right?

My next door neighbor would scream at people passing by. I’d routinely be woken at 7am due to his swearing. Things started getting worse. He verbally threatened to kill people. He bashed in an RV parked on the road by his property, causing thousands in damage. He jumped off his balcony toward a neighbor he was threatening. I went, with some others, to the police. They couldn’t do anything. If he yelled on his propery, that was his business. If the RV owner wanted to press charges, that was their business. Oh, they could offer him help, but he’d have to take it. Shortly thereafter, I had heard him calmly yelling “You think I’m scared of the police?! I’m not scared of no *Ing police!” And why should he? They visited him multiple times a week and did nothing. Two weeks later he beat his mother to death with a tire iron. Yes, we need good ways to determine instability, but some of these cases are pretty clear cut, and we have a very real problem.

It's worth noting that the same rules and protection that get applied to criminal sentences do not apply to 'treatment' and 'treatment providers' in sentencing. There are cases when treatment providers overrule/ignore judges orders and the treatment provider prevails. 18 U.S. Code § 3553(a)(2)(D) is used as a carveout for treatment in Federal code so that treatment providers can impose 'whatever is the most effective manner' even if treatment imposes rules that the Judge would not be able to impose. The Judge orders treatment, and the treatment provider then has carte blanche to impose their own sentence rules (the rules of treatment) even though in the USA only a Judge is supposed to be able to determine a sentence.

> If you're all-knowing and all-good, great. Otherwise seems like a pretty gross violation of basic human rights - what about the false positives... We could temporarily solve many of the world's problems if we had more authoritarianism, but it never ends well in fiction or in real life.

I think this is a broad argument that applies equally to prison, too; would you bite that bullet and argue for abolishing prison as well? If not, I think your conclusion is a bit hyperbolic.

In practice the discussion is (should be) quite nuanced. If someone is a clear and present danger to themselves or others due to mental instability, then it seems reasonable to me to confine them until that danger is resolved. But of course, that's a slippery slope and so the danger should be clear and substantial, and involuntary commitment should not be an indefinite thing, a tool used to take homeless off the streets, for example. A robust and independent ethics board reviewing decisions is an important component.

One thing to note is that lots of other countries do this, and the US is something of an outlier; one could just look at other countries for examples to evaluate whether this idea would present a terrible slide into authoritarianism. For example, in the UK: https://www.nhs.uk/mental-health/social-care-and-your-rights....

One could also do an A/B test by analyzing California circa 1972 when the Lanterman–Petris–Short Act ended involuntary commitment: https://en.wikipedia.org/wiki/Lanterman%E2%80%93Petris%E2%80.... Was the US more authoritarian in the 60s, when involuntary commitment was common? It's reasonable to suggest it was overused (see, One Flew Over The Cuckoo's Nest), but so were many medical practices (see, forced sterilization of women). I think it's reasonable to suppose that we use a lighter touch if we tried again.

Fortunately, this is an issue that lots of smart people write on already: https://slatestarcodex.com/2016/03/07/reverse-voxsplaining-p....

> one could just look at other countries for examples to evaluate whether this idea would present a terrible slide into authoritarianism. For example, in the UK: https://www.nhs.uk/mental-health/social-care-and-your-rights....

The English system unambiguously leads to abuse. We see autistic people held for years in secure services because it's thought they pose a risk of harm to others, but often that risk is evidenced by behaviours they exhibit while under severe restriction in hospital. I'd argue that if you put anyone in a locked room with nothing but anti-ligature clothing and keep them there for a month they'd act aggressively. See also the many documentaries about abuse, eg Winterborne View, St Andrews, Edenfield Centre, TEWV, etc etc.

> I'd argue that if you put anyone in a locked room with nothing but anti-ligature clothing and keep them there for a month they'd act aggressively.

Anyone? I can't speak generally, but the people I know that have been forcibly treated didn't become more aggressive, they became less aggressive. They got on well with the care staff, continued taking the pills on release, and were glad they'd been treated.

I've known a couple of schizophrenics, but I know nothing about their response to treatment or incarceration. My experience is restricted to a handful of people with bipolar.

There's a difference between forcible treatment, and being kept in a room wearing nothing but anti-ligature clothing, with none of your belongings, no blankets, no furniture, food being provided through a hatch in a door, etc.

It's great that you've met a couple of people with severe mental illness that had good experience of care - most people do. But it's not relevant to what I said.

Solitary confinement is torture, which is why it's banned unless there's no other option. In the English system seclusion is used far too often, and often as a first not last resort. This is also true for restraint and rapid tranquillisation. There are national and local programmes of work trying to reduce use of force, and we've even had a recent law change to prevent the use of force in mental health units. The new law recognises that people's human rights were being abused.

https://www.legislation.gov.uk/ukpga/2018/27/enacted

https://www.gov.uk/government/publications/mental-health-uni...

https://restraintreductionnetwork.org/

We're reforming the mental health act because we recognise that people's human rights are not respected, and to improve the use of advance directives and reduce the use of compulsory treatment, especially the use of force: https://commonslibrary.parliament.uk/research-briefings/cbp-...

I'm a forensic psychiatrist. If there were an easy answer to this, we would have found it already, but I'll offer the following observation:

I currently work in Oregon, where (in practice) it's more difficult than any other state or country where I have worked to admit someone involuntarily to the hospital. This has resulted in a greater number of mentally ill people staying untreated until the point that they do something that gets them arrested (which may or may not involve serious harm to someone else).

In my opinion, this particular balance between individual autonomy vs involuntary treatment does not seem to be a net positive for either the community or individual rights.

In your experience, why do mentally ill people not seek treatment?

As a general rule of thumb, the more seriously ill someone is, the less likely they are to realize it. Like every "rule of thumb" there are many exceptions, but it's true enough.

The other factor is that many medications for the treatment of psychotic disorders (psychotic meaning hallucinations, delusions, and disorganized thoughts - NOT meaning wanton violence) tend to have unpleasant side-effects. If you are convinced that you are not ill, you wouldn't want to take them either.

Thank you, that makes sense. That said, though - doesn't that mean those people are making a pretty rational decision about avoiding treatment?

A rational decision is weighing the pros and cons. If you are blind to your illness (and the ramifications, for example having killed a family member you care about because you believed them to be a demon), then how can you weigh the pros of having those delusions resolve vs the cons of weight gain and potential diabetes?

It's not always irrational to refuse, but a total absence of insight into illness precludes a rational decision.

There is no “rational” decision when your mind does not work correctly. Subjectively it is but it is objectively both wrong (because false) and imprudent (because data is discarded which should not be).

I am speaking from experience as a depressive person (not actively sick right now): I know that I do not think objectively when I am ill, but I only know this when I am not ill.

You raise a good point; it's more complicated than my simplistic response above. Glad to hear that you are feeling better now.

Thank you! And thank you for your help to people with mental issues!

Being depressed is terrible. I cannot imagine what hallucinations must be.

Oregon has a horrible history with Oregon State Hospital and Oregon's treatment of people with mental health issues. Wasn't Oregon State Hospital basically the model for One Flew Over the Coockoo's Nest? When the state has a history of abuse and torture such as un-necesary brain operations, forced sterilization, etc, then I'm sorry trust in you is lost and requires a rigorous process. I'm sure it would be nice if it was easier for you to take people's lives and rights away and send them to an Insane Assylum founded in the 1800s and with a horrible history.

Persons suffering from mental health conditions suffer them long before they warrant the "dangerous" moniker. The solution lies in substantive treatment of all mental health conditions.

The disparity of care between mental health conditions and all other health conditions is laughable, including in New York State, despite "mental health parity" rules. For those with Medicaid (public health program for those meeting certain low-income or disability criteria), this disparity isn't as severe. However, many young adults with serious mental illness are covered by commercial health plans via their parents, and it is these plans that are relatively weak when it comes to mental health coverage.

These plans do well when it comes to emergency, in-patient interventions, but fall short when it comes to ongoing outpatient support. Much of this is due to lack of participation by mental healthcare providers in the insurance reimbursement system, likely as a result of low reimbursement rates. Why see patients with serious mental illness reimbursed at $100 a session when one can see less complex patients paying cash at $150 or even $200 a session.

This has been exacerbated by the prevalence of mobile app-based therapy arrangements, which, again, are suitable for someone who is reasonably healthy and needs some additional support, but may be completely inappropriate for those with a serious mental health condition.

Mental health care parity laws need teeth. The free market will not solve this.

Most psychiatric treatments either don't work or have terrible side effects. People go off them not just because they're crazy. Which means that mandated treatment boils down to jailing many of these patients indefinitely.

I can't find it right now but Freddie deBoer had a pretty good, and by good I mean harrowing, description of psychiatric medication, then medication for the side effects of psych meds, then... It's definitely not like taking antibiotics.

Is it this? https://freddiedeboer.substack.com/p/the-weight

Yes, that's the one. Thank you.

Psychiatric treatments are largely shooting in the dark yet have always been popular among the elite. For example, the inventor of the lobotomy got the Nobel Prize in Medicine (https://en.wikipedia.org/wiki/Lobotomy). The biggest difference today is that drug companies get the money not the surgeons.

> Most psychiatric treatments either don't work or have terrible side effects.

Well, yes; even talking therapy can have side-effects (and talking therapy often doesn't work). But I take it you're referring to treatment with anti-psychotic drugs. They have bad side-effects; but they work pretty consistently, in the sense that they suppress delusions and delusional behaviour.

> jailing many of these patients indefinitely.

That's never the right solution, unless you happen to be the owner of a private secure psychiatric clinic. You confine a patient while you medicate them, and release them a few months later, once they've convinced you they'll take their pills. Then you monitor them in the community, ideally indefinitely.

> It's definitely not like taking antibiotics.

It surely is not like taking antibiotics. Anti-psychotic drugs are very blunt instruments, including the more recent ones. If you had those side-effects, you'd correctly conclude that the drugs were making you ill.

Murdering random people is a fairly terrible side effect of not taking psychiatric treatment.

Define dangerously mentally ill please. I'm afraid that such definition might not be the same, depending on who you are, your religion, your sexual preference...etc

Will the definition of dangerously mentally ill be the same in urban Vermont vs rural Mississippi?

We have a lot of problems with racism in the US. How do we ensure that this won't become another tool of oppression?

Maybe we start by not electing the dangerously mentally ill to the presidency instead.

"It's Time to..."

In my experience, these kinds of headlines are written by specific kinds of people for specific kinds of people and don't really have anything to do with the rest of us other than being forced to see it.

It's such a terrible, terrible idea to turn mental and behavioral health into arms of the police state. Horrible plan that will radically harm everyone regardless of any medical conditions they have.

>Common Sense: Honest news for sane people brought to you by Bari Weiss.

Interesting branding. I don't think I've ever seen e.g. a newspaper or magazine marketed as "for sane people."

This "I am sane I promise" t-shirt is causing people to ask me a lot of questions already answered by my t-shirt.

Are we going to forcibly medicate them?

I don't have a good answer to the problem here myself. But I'm pretty nervous about forcibly medicating folks...

Are you not also nervous about allowing them to continue assaulting and murdering random people?

Yes, but who then gets forcibly medicated?

People who present a risk? That could be a lot of people... who picks what meds they are forced to take? How can you possibly ever get out of such a system?

If you want to get into prevention, that's fine. But since most crime is committed by people without mental illnesses, you need to start by forcibly medicating the general population. Sound good?

I can't imagine that the people pushing this argument would be down with an involuntary mandate for a cheap, simple, safe, annual injection that would prevent tens and hundreds of thousands of deaths caused by a potentially deadly contagious respiratory disease, but I'm ready to be pleasantly surprised.

No, because I use my reasoning which includes taking in information about systems and balancing priorities. I am very opposed to broad reaching criminalization of mental illness. It will not stop violent crime, it will just stigmatize mental health and wellness.

We should not set policy based on a knee-jerk, tunnel-vision, trauma/fear reaction.

And anyway... Context is important: https://counciloncj.org/mid-year-2022-crime-pr/

When people say that conservatism is fundamentally at odds with concepts like the human right to bodily autonomy, this kind of nonsense is what they mean.

There is no authoritative or even moderately reliable way to diagnose "dangerous" mental illness. It is a fairly well established fact that mental illness is more associated with _victimization_ than perpetration of violence. This kind of scaremongering is entirely based in ableism, not actual "common sense."

Is there anything in the article indicating that this is some sort of conservative viewpoint or did you just decide to label it such because it seemed like an easy way for you to score a point?

I consider myself to be more right-leaning and "conservative" but neither I nor any other conservatives I know would support this. Typically, though not always, people on the right want to take away power from the government - not enhance it as this would do.

It's Bari Weiss's publication, and she describes it, and herself, as conservative.

A publication having a political bias doesn't correlate to every product of that publication being one which broadly represents its political association.

Nor can you in good faith generalize the ideas of a single person to be representative of all members of the political party that individual claims to be a part of.

This is just textbook no true Scotsman. She's a conservative, and a prominent one.

Did I say anywhere that she wasn't a conservative? You clearly misunderstand the no true Scotsman fallacy.

This thinking is the exact reasoning I try to avoid any form of self labeling. Everyone else is going to assume since you share a label you must agree 100% with all opinions of another person of the same label.

I'll add that every conservative in my life would be against this. It actually the kind of thing they hate most about the democratic party policies they complain about: government mandated. Does the topic of vaccine mandates ring a bell?

I've been mostly a lurker on HN for over a decade. I never thought I'd see the day where a large portion of the userbase supports bringing back mental asylums and forced medication.

But the mental health providers voted to change the DSM 5 to not list being gay as a mental health disorder so we can trust them now. And hope they don't change their mind, sorry I mean take a rigorous scientific vote, and change it back in DSM 6. I'm sure gay people take comfort in knowing as of the 2013 DSM 5 there are no longer mental health categories based solely on sexual orientation.

Reminds me of what happened to Alan Turing.

It’s not the 50’s any longer. Mental illness is real.

So is research that shows that mental illness has little link to violence. And, hell, so is homophobia! Let's say we make a law that says the state can black bag you and force you to take Abilify based on some arbitrary application of a psychology questionnaire by a state-employed psychologist; what's to say that a future administration doesn't reclassify homosexuality as a mental illness and do the exact same shit?

To conflate this with discrimination of the old days and use it as an excuse to prevent the ill from receiving care is contemptible.

It's not like the government couldn't make you disappear if it wanted to badly enough already.

So is gun violence, the housing crisis, record levels of inequality, a deadly global pandemic, and anti-queer stochastic terror.

No comprendo.

Right, in the DSM 5 they 'voted' that being gay is no longer deviant behavior. What a rigorous scientific system mental health professionals use to diagnose disorders.

Maybe you've never been around severely mentally ill folks, but I have and there is no doubt they exist. No doubt at all.

Trying to skirt that by pointing to a blurry line at the border of "sanity" does these folks a great disservice I think. They deserve better care than they are getting now.

There's a reason people with serious mental illness don't take their medicines: they have unpleasant side-effects.

The main type of medication is anti-psychotics. These drugs are also classed as "major tranquilizers" - drugs such as the notorious "chemical cosh" haloperidol are in this class. They suppress delusions, or at least delusional behaviour; but they make you gain weight, rock, tremble, mumble. The side-effects are progressive. Modern anti-psychotics have less side-effects than the old ones, but their effects are very marked.

For people with bipolar, their illness sometimes makes them feel alive and cheerful, and the drugs take that away from them, depriving them of affect and zest for life. Basically the pills make them unhappy.

So we're discussing forcing people to take pills that make them feel ill or unhappy. That's only justifiable if the compulsion regime is completely trustworthy. We have a compulsion regime in the UK (we tore down our asylums back in the 80s, just like the US). If you have an episode, you can be incarcerated for a few months on the say-so of two doctors. It seems to work alright - as far as I can see, they farm you out to some private secure clinic.

But between the train-wreck of US law enforcement and the US reluctance to spend money on public health, along with the heavy, heavy politicization of everything in the USA, I think it would be dangerous to adopt the same model in the USA.

Who exactly is doing the mandating though? And then it’s just a matter of time until the political party in power starts having their opposition committed for being “dangerously mentally ill”.

What's stopping that from happening now? We already have the Baker Act and CA's 5x50s.

And, indeed, when homosexuality and transness were considered mental illnesses, people were, in fact, abused using those laws. Some minors in the US are still involuntarily sent to "mental health" or "adolescent behavior" programs that are just conversion therapy centers.

> Some minors in the US are still involuntarily sent to "mental health" or "adolescent behavior" programs that are just conversion therapy centers

Are you talking about the kids who are identified as trans and put into conversion therapy?

Not only trans; many gay children and generally gender-nonconforming minors go through this.

Oh, I was asking about the opposite, where kids are identified as being trans by adults, so they are put into conversion therapy which includes dangerous things like puberty blockers and hormone treatments. Also I don't think there's such a thing as gay children since kids aren't sexually active

Wow, that's a lot of bullshit in one comment.

- "Conversion therapy" generally means programs designed to make children straight, and I have never heard anyone use it the way you're using it

- Puberty blockers are routinely used for precocious puberty in non-trans children, and are no more dangerous than any other routine medical intervention

- Given how difficult it is for minors who themselves insist that they are trans to access medical care, and the fact that I can't find any credible reports of such things happening, I don't believe you when you insinuate that adults force children into transition

- Being gay doesn't require sexual activity; we accept that straight minors can experience romantic feelings, and it's not at all frowned upon in American culture. Asserting that gay minors cannot also experience romantic feelings is simple homophobia. I was a bisexual child before I became a bisexual adult, and I dated people of the same sex in high school.

I think you meant to "here's" instead of "that's".

I haven't heard of anyone using "conversion therapy" on children to make them straight (maybe for teens or adults in the 60s or something, and in fringe groups after that). But there is certainly a booming industry around giving children puberty blockers and hormone therapy

Also there aren't trans children without adults who are leading them into believing that they are in the wrong body, be it through positive reinforcement, abuse, or whatever other means

Your final point is pretty loaded. Children don't have romantic feelings, but they will express fondness for others by emulating things that they see adults doing. I don't think you were a "bisexual child" since you were (hopefully) not being sexually engaged as a child

It's pretty easy to become familiar with conversion therapy information if one wishes to. An estimated 350,000[1] children have received such therapy. I hope this information finds you well.

1. https://williamsinstitute.law.ucla.edu/wp-content/uploads/Co...

Reading the age ranges in that post already underline the point I made earlier about this kind of thing becoming much less common in recent decades

Your point was that because you weren't familiar with the information that it wasn't prevalent. Most people would admit that they didn't know that and respond with, "Thanks I didn't know that until know."

At this point it's pretty clear that you're arguing in bad faith. I've read enough Satre to understand what's going on here. Thanks.

Your worldview is unsupported by the scientific and sociological consensus, and facts in general, and I'm not particularly interested in arguing about it. Many of the assertions you make here are simply untrue, and it's very easy to ascertain the truth by reading relevant research; I suggest you do so.

I'm not interested in researching anything behind your harmful and distorted ideology

> Your final point is pretty loaded. Children don't have romantic feelings, but they will express fondness for others by emulating things that they see adults doing. I don't think you were a "bisexual child" since you were (hopefully) not being sexually engaged as a child

You've completely changed the person's argument by replacing "minors" with "children". They used "child" once, but the context clearly didn't mean prepubescent.

I'm not sure which highschool you attended, but I can assure you, kids are in fact sexually active.

Moreover, I'm not sure if you know this, but in general, people can experience sexual attraction without being sexually active. Maybe it's different for you, in which case, just know that in this case it's probably better to switch from extrapolating from personal experience to gathering external evidence.

No it's not.

First you have to further pacify the policing and government systems of the US, which are far too often hyper violent and cruel. That process has only just barely begun as it is (starting with reducing sentencing, sane drug laws, reducing police brutality, etc).

If you mandate X for the dangerously mentally ill (which ones are supposedly dangerously mentally ill?), what you'll get is terrifying abuse of the mentally ill broadly, in many different ways.

The US is not Finland. The US is not Norway. The US is not Estonia. We're not some soft, cuddly European-style welfare state. The US has a very, very, very violent government, a superpower government that likes to abuse its power, one that often does not respect the rights of its citizens.

Before you give the governments in the US (federal, state or local) such powers of treatment (which would include forced detainment against their will, instantly walking to the thin line of human rights violations) you better pacify it first, or you will not like the results. Then we'll be here 20 years from now and it'll be an avalanche of laments about all the horrific human rights violations that happened under the Treating Mentally Ill People With Respect Act. Who could have seen it coming?!? We didn't expect them to do such horrible things with those powers! And so on.

I have had very, very, very good interactions with police regarding care for mentally I’ll relatives.

Really above and beyond.

Part of this is that our local police department has rigorous selections and training.

All cops must have a graduate degree before receiving a permanent job offer.

It is high time, we only allow one type of person to exist on this planet. I am comfortable that this type of person will not be me or anyone I personally care about so it is ok. Anyone who does not fit the mold must be identified, broken into malleable pieces and then, ideally, reset, but failing that removed from polite society.

It is a hard read, but that is this article is arguing for.

edit: Hell, I get freedom is scary. There are times I see and hear of people who use it in ways I would never think of considering thinking of dreaming about, but blanket convenient labeling, followed by drugging to ensure they can rendered docile is one of the more horrifying things a civilization can do to a person all the while proponent of the policy managing to feel warm and fuzzy about it. It certainly does not help ( and likely colors my thoughts ) that I regularly attend conferences where some well-meaning soul asks a seemingly benign question along the lines of 'We are already have data X; why are we not using it to do Y.'

This article presents an absolutely DISTURBINGLY disingenuous view of the civil-rights-forward view here.

> The underlying problem is that the ACLU and other progressive libertarians view the mentally ill as victims of society deserving of special rights, including a he right to avoid the consequences of their behavior.

No, the ACLU believes that without strong protections against forced hospitalization and treatment, people will be abused and stripped of rights in the false name of community safety.

The ACLU doesn’t just believe this on idealist grounds, they believe this because that is the legacy of asylums in the USA.

Many people want treatment but cannot find it because it's stigmatized, too expensive and/or the waiting lists are too long. This seems like a bad but easy solution to a serious problem

This alarms me considerably, as would anything that forces someone to do anything they do not want to do, whether it's for their own good or not. That said, however, I think there must be a system to treat those who are dangerous to themselves, or to society. I see the problem but once you go down that pathway where does it stop?

Government does not back down, and I am deeply concerned that a system that mandates the treatment of someone for a disease could expand that definition, far beyond what anyone intended.

We should be looking at models for how this system has worked elsewhere. If in fact the cause here is strictly biological (its likely a mix of biological and societal) factors, then there should be an even distributions in other populations.

We should look to the Netherlands or similar to find models for effectively dealing with potentially violent mental illness.

I'm confused. Is the author not simply advocating for a federalized version of Florida's Baker Act[0]?

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

No, they're advocating for forced medication of mentally ill people, so some firm of long term monitoring to ensure you take your pills every day.

This already happens. Often plea bargains include “must receive mental health treatment.”

This article itself highlights the absolute discomfort I have with this proposal, and why I think it's ultimately unethical.

They completely switch from presenting a case about the "dangerously mentally ill with a propensity for murder" casually to just the "mentally ill."

Even drawing a line between the two in the first place can be fraught with ethical difficulties, and all the "advocates" in this process are not duty-bound to the person who's mental health status is about to be "determined" by the state; and it's highly likely everyone else involved in the process will have some financial incentive to start as much treatment as is possible.

It's easy to see the imputed process here making more errors than it prevents, since it seems to be a process that can be applied before any guilt is established.

I knew this was New York before even reading this. It's getting bad out there, and we need to find a solution to address it.

It is anyplace in the US with some combination of:

-Temperate weather

-Dense environment where travel by personal vehicle is not necessary

-society does not imprison people for drug use/sleeping outside (trespassing)/other activities of people with severe mental illness

NYC qualifies for the dense environment, western US cities contend with temperate weather and Martin v Boise ruling, plus other politics that prevent imprisoning mentally ill people.

Hence suburbs that require personal cars are the best solution for those looking to minimize interactions, since the personal car serves as a credit check of sorts. And/or living in areas where weather does not permit living outdoors.

San Francisco

What about San Francisco?

I am not sure these places are nice to the mentally ill. Are we going back to lock them in the madhouse like it is a century ago?

Yeah, the thing we need is more policing and non-consensual treatment. What the hell is wrong with you?

I mean, there used to be assylums. Of course those had their own problems/abuses too (as the article points out).

"including the right to avoid the consequences of their behavior."

To me, this reeks of bias. They don't avoid consequences. The consequences are different (secure psychiatric facility vs prison). The main point of the punishment for a crime is to prevent it from happening again (and Gove the victim closure/recourse within the confines of the law). Stick a psychotic person in prison, they likely will be even worse when they come out. At least with treatment there's a chance at recovery and prevention.

There needs to be a balance between mandating treatments and freedom. Can we mandate testing, treatment, and restrictions in freedoms for infectious diseases in the name of protecting society? It seems like there's a lot of conflicting precedent on that (STIs, vs covid, vs flu, etc).

Also, if the state institutions shut down so long ago, is there any background information on the increase in the mentally ill in prison and on the street? Is there an overall increase in mental illness, or just a distribution issue? Or could it even be diagnostic sensitivity or scope creep of the definitions (likely what the ACLU and others are truly worried about, in addition to the Minority Report-esque pre-crime element)?

When my country started removing asylums, it created at the same times community and youth/family centers where you can get pre-checked with certified nurses and mediators (i used that personally), and hospitals working as asylums for long-term treatments, but not as cut of society as asylums were. We also have psychologists available at 'formation centers' (messed up traduction : basically institutes mandated to find adapted formations to people on benefits (or stuck after their useless math bachelor degree... Hey, that's me again!)

Granted, we probably the worse country in the world for that to happen, because most low-level mental healthcare workers are taught a lot of fraudulent and pseudoscientific theories like Young archetypes and other post-freud shenanigans, but it seems we are somehow better at taking care of our people than the country where most cutting-edge theories and treatments come from.

Strange that the article left out of the history the pivotal point where the Mental Health Systems Act of 1980 was about to go into effect and then was entirely repealed in The Omnibus Budget Reconciliation Act of 1981 because the new person in charge hailed from a part of the country where psychiatry was associated with Communism even though he was shot by a person with untreated schizophrenia six months before.

Perhaps in the US we could make healthcare affordable to just the "non-dangerously" mentally ill first before vilifying mental illness in general. Or perhaps, we could take a hard look at gun control laws that enable the danger instead of using mentally ill people as a scapegoat, which is what conservatives prefer to do any time there's a mass shooting.

The biggest gun problem in the US is urban shootings via hand guns, by a drastic margin.

I'd like to see a plan for removing all the illegally owned guns from US cities. I rarely see anybody talk about how to get those off the streets. Those guns are already illegal and nobody is doing anything about it, nothing that is making a dent in the problem anyway. The murders and shootings continue just as they have for decades, accounting for the majority of US murders by gun. Half of the major US cities are war zones because of illegal hand guns, and it has nothing to do with the mentally ill and mass shootings.

And yes, we should still deal with the mental illness issue around gun access and ownership simultaneously.

The issue here isn't guns though, sadly. Most of the violence from homeless mentally ill folks isn't gun violence.

Walking around SF, I (a regular looking guy) have been accosted multiple times. Its legitimately frightening, and would be so much worse if I was elderly or disabled or otherwise unable to defend myself.

Motte: Maybe deinstitutionalizing the mentally ill has gone too far

Bailey:

>The underlying problem is that the ACLU and other progressive libertarians view the mentally ill as victims of society deserving of special rights, including the right to avoid the consequences of their behavior.

The first question that comes to mind is why has mental illness been substantially increasing recently over the past few decades? Something about our lifestyle definitely contributes to it.

Love how people in this topic keep arguing about the most strawman interpretation of the article.

Noone is saying we should commit "neurodivergent" individuals with a minor Adderall addiction into mental asylums where they will be subjected to shock therapy... The article is about severely ill paranoid schizophrenics, who are ticking timebombs when off their meds.

Sorry, but this is not some "on the spectrum" hippy bullshit - these people are seriously ill and need to be treated, and kept in check to make sure they stick to their treatment.

> The article is about severely ill paranoid schizophrenics, who are ticking timebombs when off their meds.

You are suggesting that unmedicated people with schizophrenia are dangerous. That is mainly just wrong. The greatest danger that unmedicated schizophrenics pose is to themselves. And they are more likely to be murdered than to commit murder themselves.

If the definition of insanity is doing the same thing repeatedly and expecting success, then a person who got trounced in the California gubernatorial election twice is clearly insane, therefore it’s time for mandatory treatment of Michael Shellenberger.

Leaving them out is inhumane to the rest of the society. Is the right of an individual greater than society? especially one who has been violent in the past towards other members of the society either through one's volition or not?

The lawmakers and the public in American in general are not able to digest this correctly. There is no ethical dilemma here. One person who is/can harm another human being needs to be put in a place where they can't cause harm(This includes self-harm as well).

How do you propose we identify such individuals? How do you avoid false positives? And what will you do with them once you've done so? Antipsychotics? Electroshock? Just let people rot in prison for their whole lives because they answered a question wrong on a questionnaire?

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