Roughly - without the violence - a friend watched this precise scenario last fall in Spokane, WA. If the person had been within hospital grounds, the paramedics & security could have restrained them under grounds of inability to make choice, given them medications, and maybe helped them some. But, since the person was a block away from the hospital, there was no ability to say, "buddy, you have feces all over you and are laying with flies all over. we're gonna take you in, hose you off, launder the clothes, then see what we can do for your mental state". That would have been the kindest thing to do.
The crux is that certain "out of your mind" states require external intervention, and there is no legal way to apply that in many jurisdictions today. Note that some jurisdictions require a trial-like apparatus for involuntary holds after some 24/36? hour period - I don't that's inappropriate at all. Being able to see a guy laying covered in filth and take him in to help should be legal; at least for 24 hours. The indigent will have their debt forgiven - hospitals know they don't get blood from a turnip.
It is true that some medications don't work for everyone, and some medications produce horrific side effects. So there is some % of people for whom the best medication regimes today do not work. That has to be considered and reflected through. It's also true that there's high correlation with addiction and homelessness. That all has to be considered and addressed.
Considering institutions. As I've had a good friend for a long time with mental illness who has been in wards, the quote from the article is very true.
> I disliked the hospital, but even with its heavy locked door, I knew it wasn’t a branch of the “carceral state” devised by a power‑mad society to torment him.
And this has to be understood by everyone who thinks through this. Mental wards in the United States today are not, conventionally, torture chambers for mad doctors. They are restrictive and often frustrating, for reasons that a little thought should reveal. Aberrant nurses and arrogant & high-handed docs exist there, but they are not, systemically, the norm. It is not a horror movie.
TBQH, I don't think the vast majority of mental health writings online by non-experts touch on severe mental illness in anything approximating a realistic way.
The status quo is really quite unacceptable. My druthers would be to re-institutionalize and keep a very high legal and regulatory scrutiny on the institutions. Other solutions might work well too. But a key cornerstone of improvement will have to come to changing the shape of the law for involuntary holds and medication for people in high crisis.