Time to bring back asylums?
wsj.com
wsj.com
> [Cramer] frankly discusses the “regimented, often hopeless conditions of state mental hospitals”, talks about a hospital in Alabama where “care was worse than simply inadequate: one psychiatrist for 5000 patients; astonishingly low funding for clothing, food and upkeep of the buildings”, studies showing that institutions never actually got patients’ signatures on the forms that were supposed to waive their rights to court hearings.
> [He] describes the case of Edna Long, who was hospitalized for “public drunkenness” and “permanently hospitalized in 1952. As Ennis tells the tale, Long received no treatment during the next fifteen years, but was kept busy working at menial jobs in the hospital. After the death of her husband in 1960, the state hospital had her declared incompetent, and seized her assets to pay for her care. Then, they put what assets remained under the management of an attorney, who made a bit of money from reducing the value of her estate by 86% (according to Ennis, a common practice at the time in New York). Once Long had become too physically ill to continue working, the hospital suddenly found her “competent to manage her own affairs” and released her, to a life of elderly poverty. Most of the money that she and her husband had accumulated had been consumed by attorneys supposedly protecting her assets.”
[1]: https://astralcodexten.substack.com/p/book-review-san-fransi...
In a sentence, we need a public infrastructure in place to care for the mentally ill that currently are forced to live on the streets of our major cities. We need a way to pay the people that do the work, buy the buildings, keep the lights on. We call this infrastructure asylums, whatever you want to call it we need it desperately.
If you want to stop things like what you cited from happening, lobby to have rules and regulations surrounding these institutions that get you what you want. But it doesn't mean we don't need the 90% good they will do for fear of the 10% bad they've done in the past
It's not about what to call it, it's about whether people are forced to be there.
(Most places have something in-between: policies that exclude a fair number of homeless but still leave enough behavioral issues to produce dangerous and unpleasant places).
Of course, resourcing is part of the problem, but it also just can't be one-size fits all.
If you're set to be stuffed like canned sardines in small rooms, for example, there are fewer boundaries regardless of "policy".
If we see that someone in freezing weather prefers sleeping outside to sleeping in a homeless shelter, we're forced to reckon with the fact that homeless shelters must be terrible.
If we lock this person up in an equally terrible asylum, we can ignore that.
Yes, in some cases people should be forced to be there. In other cases no way.
It's not about a specific thing like this. It's about setting aside the resources as a society to deal with the problem, pay experts, and then do what they say. It will take time, we will have to course correct along the way, but we have to first agree to take the journey together.
I'm behind you, when are you starting? We have lots of people that need help, please hurry.
Of course you could imagine shelters where people are allowed to stay all day. Or housing first programs. The relevant difference is still whether people are forced to be there.
> Also, there are many homeless families (shelters don't serve them that well), but when it comes to mental illness it's not usually a family thing.
I'm not sure I understand this argument. Shelters don't serve families well because they can't stay there together, but this is not a problem for asylums, since asylums would only take those who are mentally ill — so families can't stay there together either, but that's not a problem in this case?
Your feelings, whatever they are, that lead you to your opinions, political principles, or ethics, are inherently immune to being invalidated by others.
However, it makes me nervous to read comments such as yours, because my first reaction is that I can't tell what motivates you.
Oftentimes deep feelings come from personal connections.
If person A had a loved one who became homeless, and person B spent a week in a mental hospital, then those people might naturally have very different reactions to history or public policy debates.
Neither is right or wrong, but either might learn from the other.
>Your feelings, whatever they are, that lead you to your opinions, political principles, or ethics, are inherently immune to being invalidated by others.
You don't know me. You can't possibly know something like this from one comment on the internet. It seems that others have said this to you in the past, and you are just parroting it to me.
Best wishes, much love
That possibility ("a commonly held belief") indeed is the reason I thought it worth engaging.
I don't think I can see your upvotes, and discussing voting is against the guidelines.
>It's not as if I came up with this opinion out of thin air.
It would be unreasonable to assume you did. Yet that doesn't give me a hint where your opinions do come from, which is why I was - and am - asking.
>You don't know me.
That was the gist of my whole comment. It's unfortunate if the meaning of the whole thing was somehow inverted.
>You can't possibly know something like this from one comment on the internet
Something like what? You quoted a sentence that tried to communicate, in short, nobody can judge you.
My entire comment was a disclaimer or admission that I know nothing about you nor can I judge you, and a solicitation of information.
>It seems that others have said this to you in the past, and you are just parroting it to me
Every word I wrote was original to me and expressed my thoughts at least for one particular moment.
Do you think repeating beliefs that others hold is bad? I don't think it's good or bad in itself. By the repetition of an idea, you make it your own, and there is always a good reason for doing so...but that reason is unique to you and not made clear unless you choose.
Asking about your reasons may seem intrusive, like asking if you want to open yourself to bullying from all and sundry, but I strongly believe in this principle:
What convinces you of a thing is the best possible argument for convincing other people
Constructive dialogue on anything cannot take place without some willingness to treat discussion as more than a tactical game.
Not participating in constructive dialogue is everyone's right. The benefit to you, the carrot and not the stick, is that you might one day rightly convince someone, somewhere, in the world of something you believe in.
Who knows, you could be the first person to convince anyone of anything on the internet in the last half century.
Maybe that's putting the cart before the horse?
How about what is needed is changing the conditions in society, workplace, and culture, so that fewer people end up "mentally ill", and those that are environmentally or genetically mentally ill do not get broken and marginalized and have their conditions gravely worsen, as do their "solutions" (from isolation, homelessness and living on the margins, to drug abuse, murders, or even mass shootings)?
(Wow, downvotes. Fixing the cause as opposed to a band-aid is controversial. Well, I guess you get the society you deserve).
Kind of how other first world countries (even nominally poorer ones) only have a tiny fraction of the problems with mentally-ill homelessness, crime, shootings, and so on.
(Or taken a few additional centuries to get there)
So this argument kind of backfires...
All I’m saying is, there will always be people that need to be inside jail rather than outside jail. The parent asked for a citation. I said Hitler. Because it would have been better if he was inside jail and not running it.
Another one: Charles Manson. He was jailed. I don’t think there is any society where he could have lived and not committed atrocities. Unless you lived in a society that legalised such atrocities but I’m not interested in living somewhere like that.
It's weird to choose an obscure, older historical reference to suit your point, while the literal best example possible, the example that created the term, is sitting right there.
Changing those conditions, even if everyone could agree on what needs to be done, and the political will were there, right now, will be a multi-year -- perhaps multi-decade -- process. I don't think we should let people suffer while we wait for that to happen.
I think we should start committing mentally ill homeless people to mental institutions, and force those addicted to drugs/alcohol into rehab programs. They need to be off the street in safer environments for these treatments to be successful. After those problems are dealt with, we can put them in supportive housing and get them into job training and placement programs.
That's not going to be perfect; it may just not work for some people. But it will work for many, and our cities will be safer, healthier, and cleaner as a result. The problem is that there are not enough resources and funding, and the political will to fix that isn't there.
And yes, we need to fix structural problems too:
* Neutralize NIMBYs who fight new housing; once the formerly-homeless get through their treatment programs and are in a position to be back on their feet, we need places to put them that aren't insanely expensive, especially if we expect these new residents to eventually start paying for their own housing.
* Raise minimum wages (somehow also for salaried workers in addition to hourly), with automatic yearly increases indexed to inflation or CPI or whatever. Eliminate the distinction between tipped and non-tipped workers; base wages should be living wages, conforming to the minimum wage laws.
* Either a) put some differential/ratio-based caps on executive compensation, or b) tax the shit out of high income earners to fund fixes to income inequality.
* If we can't get some sort of universal healthcare, at the very least we need to require that health insurers cover mental health and addiction treatment at much better levels than we do now.
But fixing structural problems takes a lot of time. I don't see better mental health & addiction services as putting the cart before the horse; I think both attack vectors are essential.
Under the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008, medical insurers are already required to cover mental health the same way they cover physical health. The issue is not so much with insurers but availability of providers. It doesn't matter whether your insurer will pay the claim if you can't get an appointment with a local psychiatrist in the first place.
Paying people a living wage is not a handout. Raising the minimum wage is not a handout.
These people are working, hard, harder than you do, for way less. These people are being taken advantage of. It's not just fast food workers, it's bank tellers, it's farm workers, it's orderliness and custodians at hospitals, it's the backbone of our society.
What do you get paid to do? I would argue that what you get paid for what you do is more of a handout than raising the minimum wage of a janitor, which isn't a handout at all.
A better solution would be to eliminate the minimum wage entirely and instead expand the Earned Income Tax Credit. Basically have negative income tax rates for low income workers. This would cut unemployment and allow those people to start gaining some real job skills.
If you wouldn't mind reviewing https://news.ycombinator.com/newsguidelines.html and taking the intended spirit of the site more to heart, we'd be grateful.
You don't even have the answer, you're just listing the effects and stating they are bad and that we should not have them. No shit, the problem is what to change and what the effect will be.
I'd say we have a very good idea. It's just denial when people are pretending we don't.
Conversations get no where if you're going to talk nonsense.
We don't (feed and house everyone) because the people who grow and distribute food need to get paid.
Australia has public healthcare and public housing. I myself am a beneficiary of that, as my parents were homeless. I got out of the cycle because there's things there that helped me. But I am 1-in-a-1000 case.
It's not "give them more" that's needed, there's many factors in play. Drugs, mental illness, and even the mentality and language around it.
Everyone I knew in homeless shelters as well as my family (except me) were either completely ignorant of how money works, or staunch communists who didn't believe in working for the man, with drugs and illness mixed in.
Edit: also power, water, wastewater, internet for a house are services run using limited resources
Then let’s talk about restaurants and grocery stores and farms and factories where food is routinely thrown away daily. Can’t let employees take food home from the fast food joint because then they’ll just make extra food, so instead you end up tossing tons of perfectly good food. I’d help my dad pick up “old” food from grocery stores for a local shelter and they had to still only take some because the volume of usable food being tossed was too much for one shelter. There’s plenty of food.
Power, water, waste, internet - if suddenly everyone who didn’t have these things did have them, do you think the infrastructure would crumble? If, for instance, every vacant property that has working power/water/sewage/internet was filled, would that be too much strain? Would the system that was planned for that capacity buckle under the weight of what it’s made to bear? I don’t buy it.
Overall you're right, but you also might be surprised at how fragile and insufficient our infrastructure is. There are many documented cases of problems with power delivery when sudden spikes in usage occur. There have been a few articles about it just this summer due to the record breaking heat. Internet services routinely oversell their service on the assumption that most people won't use what they pay for, and any customers who try to use every bit they're paying for will have their service disconnected.
These restrictions are artificial too, people and companies pocketing millions (if not billions) in profits could easily improve their systems to meet higher demand but even though they are swimming in money and have everything they need they won't tolerate earning a penny less, and they act like they're dying when their profit increases if it doesn't also increase at least as much as it did last quarter. They just push all the costs to consumers and taxpayers who are already struggling under the unending greed of countless other people and companies.
That's why the idea of giving people food, housing, and healthcare scares the shit out of some people. They know that somehow, they'll end up paying for it, even when the reality is that often their lives would be much better anyway. The truth is that it shouldn't have to cost the people who can least afford it.
[1] https://youtu.be/2n_au5Hje_E - Some More News - The Perverse Incentives of Utility Companies
For what it's worth, I worked for a while at a fast food joint that did allow employees to take food home, or to make extra of it and just consume it on premises during lunch break. Leftover food was frozen and donated to a shelter twice a week. This place is still in business and as far as I know still operating with these policies. Cynacism aside, I don't even think the place is that unique. If you look around you will find lots of groups motivated by something more than just the mighty dollar, perhaps even most enterprise. This despite the corrosive effects of capitalism you're fretting over.
> All the excess you cite is a result of this (albeit flawed) capitalist system we live with.
My original point was responding to the bemoaning that we don’t have enough resources for everyone. Well we do, they just get wasted. We’d still have those resources or at least the ability to create them under any other system.
I completely agree that we have "enough" for everyone at this point in time and many of our ills reduce to a distribution problem. I very much do not agree that just any other system could have brought us to this point.
Intuitively if we could snap our fingers and make all money disappear tomorrow life would go on without a hiccup or any noticible change so long as everyone just keeps doing what they're doing now. But that's the rub, would everyone keep doing what they're doing?
Our economic system is the system attempting to solve this distribution problem. The optimist in me still believes we can create a better system, but I have spent years trying to understand what that system looks like and I have yet to find it. (I am still eager to hear your proposal.)
I am increasingly convinced the solution will ultimately need to leverage our modern and novel digital communications networks as well as other recent and perhaps future innovations, so I don't agree that such a system could have just arisen at any point in the past and carried us here.
As an addendum, I believe any system that effectively solves this problem while delivering the same or higher level of resources for humanity will run into the issue of destroying the planet. This is an orthogonal problem that the optimist in me also believes we will eventually find a solution for, but if we don't the discussion will become somewhat moot.
“ We can house feed and care for every person on the planet but we don’t because money. A made up concept that has no actual value outside of what we place on it.”
Try do anything you are talking about without the involvement of money or barter. It ain’t going to happen.
No one is going to work in a crappy job if they can avoid it.
Who is going build new properties or repair dilapidated buildings without money or some other incentive?
Why would anyone build more than they personally need?
Who is going to build/repair/modify homes for disabled people to live in without financial incentive?
You need money for all of this.
Unfortunately, this is more of a city level issue where a disproportionate amount of people are in the large metropolitan cities of San Diego, San Franciso, and Los Angeles. It probably can be handled if we could move them to other counties, but other counties don't want to inherit that burden. Even if a few did they very likely lack the infrastructure and staff to really support something at scale (not necessarily ALL of these homeless, simply enough to start having the population decrease faster than new ones are created.
The pentagon has failed 5 audits in a row.
Money is not real.
USA 17.5 per 10K Canada 10 per 10K
Americans like to think that universal health care solves every problem but it really doesn’t. It’s a good system and helps many things but not a panacea.
We need things that are doable but we don’t do them because capitalism doesn’t allow for it.
Do we need more safeguards? Yes. But inpatient mental health treatment needs to be viewed as a first line treatment in some cases, rather than a treatment of absolute last resort.
* Family doctor or clinic visits for mental health * Psychiatrist visits * In most provinces, medications
Talk therapy through a psychologist is what is generally not covered outside of work insurance. That’s a big gap, but also not quite right to say “not covered at all”.
Additionally, because of artificial constraint in the supply of psychiatrists (and doctors in general to a lesser degree), the wait time to see one can reach ~1 year, which doesn't have anything to do with how healthcare is financed but is still a problem in Canada.
That said healthcare isn’t housing, addiction services, or mental health services.
It turns out that when it's easy to steal things that people need organized crime will get low-level people like drug addicts and petty criminals to steal the goods for them who then give it to an intermediary middleman who then moves it to the person at the top that then resales it online and they're able to have fantastic prices because they have no no unit cos. In fact in many cases a lot of stolen goods tend to end up being part of organized crime not homeless or needy people that need things. People who need things generally we have a robust social safety net that includes things like food stamps and housing assistance in many parts of the country already.
It’s easy to fence is the reason it is locked up.
It's a crude system, more ad-hoc evolved than intelligently designed, and definitely historically manipulated at every chance. Nonetheless, anyone who lobbies for the dissolution of our monetary systems can't be taken seriously unless they also are arguing for a suitable replacement of this functionality.
In the past, systems that relied on the opinions of a small group or single individual to determine the value of different types of production to society have failed spectacularly so the solution will need to be more robust than that.
What alternative are you proposing? You are always welcome to donate food to the hungry, as many of us do.
I’ll give you a hint: it’s not for the reasons you think or the people/places you’re talking about.
and make healthcare accessible.
Did you just make them up?
It is mind-boggling to me that this is at all debatable.
Obviously we need to mandate levels of treatment and care, and constantly audit institutions to ensure conditions are maintained at a high level. But this is not even remotely an unsolved problem. We shouldn't let the failures of the past force us into failures today.
Yes. This is what we need; the fact is, many mentally ill individuals need help, but are not capable of realizing that they need help, and will refuse any attempt to offer it. Without the power to detain such an individual against their will, that person will remain on the streets, which is a worse outcome for both that person and also everyone else.
If you can suspend the rights of someone declared mentally ill, the unscrupulous parts of government will be tempted to declare politically inconvenient people mentally ill and strip them of their rights. Even in the United States, this happened during the suffragette movement; those women hunger striking for the vote were sometimes imprisoned in asylums for hysteria.
Even something as simple as detaining a criminal is "carving out an exception to human rights". You're correct that this could be abused, but so can any law. It's possible to mitigate though; that's the entire reason for the concept of an independent judiciary.
Few people would suggest that not having prisons is a better alternative than having them, however unpleasant. Similarly, in a world of deinstitutionalization it seems unlikely that 500k people living on the streets is the best of all possible worlds.
If anything its an example that suggesting to bring back asylums should be considered synonymous to an advocacy where the abuse of detained people is taken into account as an acceptable cost.
But mind you: The last time we implemented detaining people, this was in border control, and resulted in the border patrol trafficking children through abusing the child separation policies at the time. There are still tens of thousands of missing children from this policy, implemented for a scant few years.
Obviously a problematic/crass analogy, but think of it like getting a hamster before you get a dog. Prove that you can take care of prison 1, and then maybe we can talk about you getting prison 2. But if you can't take care of prison 1, you probably aren't going to be very responsible about prison 2.
And I just don't know if you're ready for prison 2 yet, prison 1 still has a lot of human rights violations in it. Prison 1 doesn't really make feel like we all know how to avoid committing human rights violations against people with mental health issues, it really makes me feel the opposite.
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I don't know, I genuinely don't mean to be snarky about it, just... it's a little weird and uncomfortable to be sitting in the realm of theories while discussing a system that actually exists in the real world and that horribly hurts people on the regular, and to say, "we'll just expand that and have the same standards." People with mental health issues already get incarcerated and they're treated horribly, and we're glossing over that when we talk about incarcerating more people.
I think we have to accept that, unfortunately. Our current situation is untenable, and there really just does not seem to be any way to "fix" someone on the streets with a mental illness without committing them to a mental institution. If you do believe there is another way that will be broadly applicable and successful, please suggest alternatives.
I'll agree that we also need significant structural changes to society (which will lessen the number of people who end up in these bad situations in general), but those changes will take years (if not decades), and the bleeding needs to be stopped in the meantime.
This is basically the argument of the pro-gun-control folk. The counter-argument I keep hearing is that rights are sacrosanct, any concomitant negatives are the price of liberty.
Saying that I agree we need to bring back a new version of asylums. I’d hope there’s a bipartisan project there.
This can be the case for literally any legal system. It's why checks and balances and an independent judiciary are important.
I think something went right, then wrong with the treatment of mental illness in california.
Years ago, when the laws were changed to allow mentally-ill but benign or even non-ill people to escape the "snake pits", lots of people could recover.
But later state mental illness funding was cut.
Now clearly mentally ill people - who needed help - were turned away unless they were clearly "a danger to themselves and others".
Many homeless people are these mentally ill people, and can't get help (and they can't be forced in unless they are dangerous, which is usually how recovery begins).
Additionally, some clearly mentally ill people suffer from anosognosia, which seems to fix their self-image in their mind to eliminate any self doubts or insight into their mental image.
At a minimum, there needs to be a way - with checks and balances - to support recovery for people who don't have insight into their disease, and the current system doesn't provide it.
I also think it would pay for itself, as lots of mentally ill people don't get proper treatment, yet are still a huge burden on the health care system.
I'm not saying you're right or wrong, but why do you believe that?
I'm having difficulty finding the source, but I've read that individual "frequent fliers" have consumed hundreds of thousands of dollars of emergency services without receiving substantive care that would improve their situation.
Just an anecdote, I don’t see any late night “urgent care” places anymore. If they were sufficiently less expensive than ERs, it seems like insurance companies would incentivize them to have longer hours. Otherwise, after 9pm, you have to go to ER.
Two main reasons: you need to use personnel, equipment, and rooms that can offer the highest levels of care. And you need to pay for having a facility staffed to handle worst case loading (with triage) 24/7.
You also tend to have pretty exhaustive testing on the "emergent" side to make sure everything is immediately OK prior to discharge.
Further, tacking on “serious chronic mental disorders” is basically a non-sequitur and could’ve been replaced with “diabetes” or “broken legs” or “tooth pain”.
If your local urgent care can’t find a doctor or NP willing to be on call late, they can’t stay open late. Given the shortages, expect the problem to get worse.
> With a budget of more than $330 million, the San Francisco Fire Department responded to more than 136,000 incidents last year — about 28,000 of them fires and other nonmedical calls for service, plus just under 12,000 false alarms.
https://www.nytimes.com/2015/08/27/us/san-francisco-firefigh...
The police and emergency responders can be called, but are unable to take any action to help a clearly mentally ill individual unless they are a danger to themselves and others. The same is true for doctors/hospitals/emergency rooms.
It is common for an individual to have 20 or 30 public service calls before they are admitted and start to receive guided treatment. Even individuals with caring and attentive families can and will fail to be treated, with damage to their mental state, or at a minimum long costly delays to their recovery.
read about "5150 hold" and the criteria required:
https://en.wikipedia.org/wiki/Lanterman%E2%80%93Petris%E2%80...
I don't blame the police, they followed the law. But in a case like that, where a person seemed very dangerous (and ultimately was), had a history of severe mental illness, was off their meds.. it seems like you need a way to intervene before the ill person does something dangerous.
1) very temporary ‘fixes’ to what are almost always conditions caused by some kind of chronic situation - often bad environments, toxic families, serious psychiatric and drug problems, major life events which don’t just go away, ongoing manipulation or emotional abuse by someone near the person, etc. often many of these things all at once.
2) very traumatizing on their own with severe long term legal and monetary consequences. Practically speaking, people lose a significant amount of rights they never get back (including the right to own firearms [https://www.atf.gov/file/58791/download], the right to adopt kids, hold many jobs, etc.) the moment they get a 5150. Getting a 5150 is one of the few ways one could lose custody of their child for good, at least in California. If someone has a legitimate history of psychosis or other serious mental health conditions, that’s all probably a good idea and legitimate! there is also a history of abusive folks using things like 5150’s to abuse and target folks they are trying to control (like abusive parents, ex spouses, etc).
Getting thrown in a psychiatric hospital against one’s will is not a pleasant or comfortable situation for anyone, let alone someone going through a psychotic episode. But the best society has come up with so far, and definitely better than them stabbing random strangers on the street (or themselves), or being thrown in genpop. Usually, anyway.
It’s a short term ‘fix’ for what is often (but not always!) a serious long term problem. Which is better than nothing!
Emergency and Long term involuntary commitment has a long and storied history of being seriously abused to steal people’s assets and manipulate/control folks who clearly were not crazy or a danger to themselves or others by any real definition.
It’s also a necessary tool when attempting to manage serious mental health issues in the population.
In both of these cases though, do you really want to set the bar so that it doesn’t require a clear, documented by a third party and actual/present danger to someone before it gets used?
Because I guarantee if you do, it will be used by angry spouses, controlling parents, political/business opponents or leaders, etc. against sane people all the time. More than it already is, anyway.
Which is often.
SF has a serious problem. Actually using 5150’s more isn’t likely to help though as most of the people getting them likely already have gotten them before. It’s a revolving door.
They get screwed up enough to warrant an emergency hold. They get help, temporarily stabilize, and within a week are back to the same situation. Eventually, they go psychotic again, and rinse repeat until they die or figure out how to get out of the cycle. Many die.
Unfortunately the police will tell you bluntly: "It's not against the law to be crazy"
More unfortunately, medical personnel have told me that unless a treatment regimen with appropriate medication starts, the brain will deteriorate and chances of a full recovery disappear.
Unless there's a separate medical system for the homeless/ mentally ill - I just don't see how it'd work. The American healthcare system is fucked, and cannot be unfucked for just the homeless (who can't pay). Most people are happy to ignore the state of affairs until there's an untreated schizophrenic hanging out in front of their favourite Avocado Toast joint.
Unless mental illness is criminalized, police have no business detaining the mentally ill or forcing them into treatment.
This doesn't require a separate medical system, it requires prompt intervention/treatment at the beginning of the illness, not after many many visits.
I fully agree. The same goes for cancer, dental health and countless other diseases and ailments. The solution is having a stronger social safety net - but America appears not to want that, so here we are.
Anytime i read a comment about spending being cut or austerity it never materializes when I look it up. I blame the media that reports "cuts in the future anticipated spending growth" as "cuts". So basically someone said spending on X will grow Y percent a year and someone else comes in and changes Y to slightly lower.
Sure enough:
> The chart below shows that over the last 10 years, state budget expenditures on health have increased nearly 8% per year, while spending on education, transportation, and natural resources has increased at less than half that rate.
https://www.chcf.org/blog/californias-unfinished-business-ad...
https://calmatters.org/justice/2019/03/hard-truths-about-dei...
https://www.kqed.org/news/11209729/did-the-emptying-of-menta...
"1967 Ronald Reagan is elected governor of California. At this point, the number of patients in state hospitals had fallen to 22,000, and the Reagan administration uses the decline as a reason to make cuts to the Department of Mental Hygiene. They cut 2,600 jobs and 10 percent of the budget despite reports showing that hospitals were already below recommended staffing levels."
"1967 Reagan signs the Lanterman-Petris-Short Act and ends the practice of institutionalizing patients against their will, or for indefinite amounts of time. This law is regarded by some as a “patient’s bill of rights”. Sadly, the care outside state hospitals was inadequate. The year after the law goes into effect, a study shows the number of mentally ill people entering San Mateo's criminal justice system doubles."
"1973 The number of patients in California State mental hospitals falls to 7,000."
So in six years the number of patients in state [mental] hospitals falls from 22,000 to 7,000, and in the FIRST YEAR ALONE after the initial cuts the number of mentally ill patients entering the criminal justice system in just one county doubles.
This was on the first page of the google results.
california: https://en.wikipedia.org/wiki/Lanterman%E2%80%93Petris%E2%80...
"Some family of mentally ill individuals believe that the LPS act favors the individual's civil rights too much when weighed against their self-evident need for treatment. It can be very difficult for their family member to be placed on a 5150 hold or on a LPS conservatorship. The LPS Act requires a "grave disability" to provide oneself with food, clothing, or shelter. Thus an individual may indeed be highly symptomatic, displaying paranoia, delusions, mania, etc., but if he or she can present a cogent plan to care for food, clothing, and shelter, he or she may very well be released from psychiatric care"
If you look around, you’ll find a dearth of facilities in the community that can handle mentally ill, mentally disabled, and addicted people.
The expenses you reference are mostly Medicaid growth, of which a relatively small proportion is mental health related.
This is the truth. But the answer is not to go back to the system that the current one replaced (every US state has horror stories, in my state's case it was so bad someone opened a haunted house in the former state mental hospital), which was by all means, a lot worse. Right now the current system is so poorly funded that it has huge quality problems, care is largely inaccessible to people who need it, and workers burnout on high hours/low pay.
> I also think it would pay for itself, as lots of mentally ill people don't get proper treatment, yet are still a huge burden on the health care system.
Not to mention our social welfare system, judicial system and so on.
People talk as if this standard is the source of problems, but it's a fine standard. We just don't enforce it.
Eg, if a homeless drug addict overdoses and is brought back by the fire dept with narcan, this is clearly someone who is a danger to themselves. They should be treated no differently than someone rescued from a suicide attempt.
Fentanyl itself changes the imminent danger of being an opiate addict because there's no remotely safe way to use it. Any chronic user of Fentanyl is a danger to themselves.
Someone who is unable to maintain basic level of health on the street is the same. Do you have infected wounds festering? Teeth rotting out of your mouth? The government would take away a pet dog from someone in that state, but for a human doing it to themselves, no problem.
Ethically, due to having their minds hijacked by addiction and/or mental illness, it is as if they're reduced to being children again. We don't put children on the street and respect their decisions to ruin their lives, because we understand they don't have the mental capacity to decide such things.
Practically, it's probably net cheaper for tax payers to force them to get clean or go to a mental hospital. But you have to account for all externalities and opportunity costs, which no one does.
Mental health, and a lot of other societal issues (homelessness etc) all need a socialist/common good type solution.
Unfortunately, I just don't see the US being able to get it together, especially combined with the general decline of your country as a whole/on average.
People with a good support network might find it easier to comply with medical orders than someone in a very precarious living situation. So forced institutionalization will likely affect the marginalized the most. It's still the right thing to do if the risk is severe enough.
This is a bit of a flawed argument-- it's not clear that people with severe mental illness are more violent than the general population, and if they are, it's not by a huge margin.
It's also flawed because we already can forcibly hospitalize people who we can prove are a danger to others. (Yes, I'm aware a whole lot slip through the cracks, but this is a resources and administrative capacity issue, not an issue of the laws we're operating under).
Have you been around schizophrenics ? Particularly those that go off meds ? And many do from time to time. "Mental Illness" is a broad term. But people with psychosis (the two most major and "severe" diagnosable forms being schizophrenia and bipolar) are clearly more prone to violence, particularly schizophrenics and particularly those who don't take their meds. Anyone having any experience with those haunted with psychosis can absolutely agree they are more prone to violence. I agree with being able to hospitalize people who prove dangerous but it is usually for a very short period of time to deal with some acute episode.
This practice is widespread today minus the slave-labor component in the form of the guardianship system, underwhich people who work as "guardians" give kickbacks to healthcare providers to identify wealthy geriatrics. The guardian, once one of these victims is identified, has them declared incompetent (even if the victims are still living independently with no apparent problems), and then takes over all their financial resources and complete control over their healthcare. The end result is the elderly person or couple is forced into a nursing home against their will; their family will be barred from visiting or corresponding with them; and the guardian walks away with a percentage of their net worth (with the reminder going to the cost of the nursing home). In states that are popular destinations for retirees like Nevada, the court system sees families who oppose this fraud/practice as evidence in favor of it happening, with judges & guardians often arguing that it shows the next of kin(s) are only concerned with money and that's why they don't want their (up until now healthy and independent) retired parent going into a bottom barrel nursing home.
> What this person wants to bring back is the ability to lock people up and keep people locked up there with little recourse.
What they want, is a way for socially undesirables (an intentionally vague and flexible category) removed from society in a way that avoids the guilty emotions invoked by executing them.
The asylum system in the US was not dismantled because people like Edna Long had their inter-generational wealth stolen from their children/grandchildren. It was dismantled because in the 1960s it was shown that these places were engaging in torture. The journalist who broke the Pennhurst story (that culminated in the ending of the asylum system in the US) wanted to have the grounds turned into a museum modeled after the Holocaust Museum because he had uncovered how things like, full mouth tooth removal was being used as a routine punishment method, among other things.
The cruelty towards these people was the goal itself. People were warehoused in feces without clothing instead of employing enough staff to change people & do the laundry often enough.
I have been to the house of Pennhurst's head psychologist from the "bad years." When he went into a nursing home a contractor bought his Federalist era farm to use it as his own-home and found that the doctor had gone insane from the guilt that his career had given him; he lived his last decades off the grid with no heating, electricity or running water; had a hole in the decaying roof that he had dragged a 19th century clawfoot tub under to collect water, and filtered the rainwater through old bedsheets and used that for cooking/drinking. The farm, with brush & grass 3ft thick grew over everything; the barn filled with a massive dragon's hoard pile of intellectual books (many of which I got to keep as souvenirs), while the hidden loft had been turned into some kind of computer & photography studio with restraints, camera arrays and so on.
I forget whose case it was, but sometime after Kaczynski was sent to ADX Florence, there was a criminal who was sentenced to join him there. The judge remarked at sentencing that they were to be sent "where people's souls go to die" or something to that effect. That. Was the real purpose of our state Asylums.
Places that lock up people against their will with little recourse are called prisons these days.
To be fair, prisons always existed, it's just that now, the're primarily used for putting away folks suffering from mental illnesses and dependency to substances.
To call a mental hospital a “prison” is to rhetorically group it with an extremely violent, cold, and otherwise unpleasant institution. But a mental hospital doesn’t have to be.
Unfortunately, many people have little compassion for those sent to prison, so they don't particularly care what kind of conditions prisoners face. It's terrible, but that's just how many humans are.
I think most people wouldn't find it hard to show compassion toward an Alzheimer's patient, and want them to be in a safe place with good conditions and good medical care.
Why is it so hard to extend that compassion to a wide variety of mental illnesses? We've come a long way from the late 60s in our understanding of mental illness (when many abuse-riddled mental institutions in California started being forced to release their patients and eventually shut down). The stigma around mental illness has not completely evaporated today, but we've made a lot of progress.
I think it's fairly safe to say that if we opened a bunch of mental institutions tomorrow, we could come up with and enforce a humane set of standards on them, and that the abuses of the past would largely be, well, a thing of the past. No system is ever perfect, of course, but I think we'd do a lot better than back then, and we'd overall have a better situation than we do today.
Being in a controlled environment where they’ll have to take appropriate medication and treatment would be much better for themselves
It is possible to keep mentally ill in walled communities and those communities not resemble the above. There are activities which are known to help some of these people, such as gardening (plants are cheap, forgiving, rewarding, and have no real profit motive).
There are large numbers of mentally ill people who are given a bottle of pills and just released to fend for themselves. This became common after the development of certain medications and the government felt it was a lot cheaper than institutionalizing them.
> The asylum system in the US was not dismantled because people like Edna Long had their inter-generational wealth stolen from their children/grandchildren. It was dismantled because in the 1960s it was shown that these places were engaging in torture. The journalist who broke the Pennhurst story (that culminated in the ending of the asylum system in the US) wanted to have the grounds turned into a museum modeled after the Holocaust Museum because he had uncovered how things like, full mouth tooth removal was being used as a routine punishment method, among other things.
There are also many cases of mismanaged and abusive conventional hospitals for purely physical ailments. Should we shut down all ERs and stop putting casts on broken bones because of that?
To be fair, this isn't as much of an obstacle as the rest is.
Instead of throwing away money how about we treat the underlying mental illness?
They even touch on the prison population in the U.S. -- comparing a figure from their childhood (when times were good) to today: "The number of inmates in the U.S. in 1955 was 185,000; today, that figure is 1,900,000." -- while gliding easily over any further details or uncomfortable truths about that, presumably that increase is entirely people who would/should be locked up in asylums instead.
The term 'asylum' implies refuge, yes. It also refers to actual places that "were popular because they [... relieved] families of their most burdensome members."
Places that largely ended with a legacy of being "torture chambers where icepick lobotomies, electric shock, sterilization and solitary confinement turned humans into zombies."
The presented model of success (the Worcester Recovery Center in Massachusetts) is described as something completely unlike the article's own description of asylums.
Note: the title on the article is the assertive 'It’s Time to Bring Back Asylums', not phrased as the question it is on HN ('Time to Bring Back Asylums?').
Reinventing the E.R. For America's Mental Health Crisis (subtitle: EmPATH units are advancing a radically new approach to psychiatric emergencies. It seems to be working.)
https://en.m.wikipedia.org/wiki/Deinstitutionalization_in_th...
The trades come to mind.
At some level these should be mutually exclusive conditions; one (unable to integrate) is the major fact that disproves the other (competent enough for self-determination).
"but would become sufficiently lucid to disinter themselves before discontinuing medication and resuming drinking and drugging."
If someone is forcibly committed to an institution, there would almost certainly need to be a set of steps to transition to a non-institutionalized way of living. For example, a probation-like system to monitor progress and look for signs of relapse and non-compliance would almost need to exist. Halfway house stays may also make the transition more likely to stick. probably some combination of those.
Much of this sounds like the kind of things you do in criminal matters. It's not surprising that it would. The resemblance is only because both deal with behavioral issues requiring the denial of personal liberties. However, we mustn't view this kind of thing like its about criminality, someone that isn't sufficiently mentally sound enough to support themselves isn't a criminal: almost certainly not from a moral point of view.
But at some point, the impacts on society by the extremely mentally ill can be just as negative as someone acting with criminal intent. So appropriate responses may look similar, but for the mentally ill they should not be punitive.
Except that just isn't even remotely anything like true. Every adult is presumed competent until a court has declared the converse and merely mental illness is not by itself sufficient to provide this.
https://www.law.cornell.edu/wex/mental_competence
It has a legal meaning that isn't malleable to meet what you think ought to be true. Merely being a loser who wants to live in a tent and do meth doesn't make one legally incompetent and in fact any attempt to patch that bug with law alone will probably run into constitutional challenges
Who's disputing this? If we start with the person already being hospitalized, which seemed to be true in your comment ("were interred there") my comment stands. If by "interred there" you mean self admitted, well, OK... sure they could check themselves out... but that's not the scenario that the article raises. The meaning of "interred" as I understood it, and a brief review of the article seems to agree with my understanding, we're talking about an involuntary commitment. If that's the case, we can presume a legal process was performed to get the person in question in the hospital in the first place: establishing legal mental incompetence. Therefore, a legal process regarding release should, if its to be consistent, operate on the premise that, "one (unable to integrate) is the major fact that disproves the other (competent enough for self-determination)".
"Merely being a loser who wants to live in a tent and do meth doesn't make one legally incompetent and in fact any attempt to patch that bug with law alone will probably run into constitutional challenges"
And the initial premise has been challenged, kind of... the 9th circuit stopped Boise, ID from breaking up a homeless encampment on the grounds of cruel and unusual punishment. But Boise didn't actually provide for an alternative to the encampment: it fined and sentenced them to a a day or two in jail (most of them were sentenced time served)... the response was entirely punitive. Note that the right to camp/do wherever you want, uninvited, on public or other's property wasn't the right being protected: there is no constitutional right to that. It was that arbitrary punishments were being dolled out.
Having said that, there are already laws already instituting involuntary treatment and hospitalization, so the constitutional challenges may not be so clear cut as you might think:
https://en.wikipedia.org/wiki/Baker_Act
https://en.wikipedia.org/wiki/Lanterman%E2%80%93Petris%E2%80...
And there lies the core of the paradox: We can't pull that off with run of the mill geriatrics. Bottom barrel nursing homes, like the kind medicaid pays for, are hell holes. And the plight of an old patient who has no family left to advocate for them, is not an acceptable one in the least bit.
If we're not going to properly handle this responsibility -now- for a sympathetic polite and docile old granny, do you really think the funding & care for 20s-50s aged mentally ill patients would be appropriate?
Depsite the challenges, we must try.
The existence of these challenges does not mean we shouldn't try.
I think that's the problem, we spend so much energy arguing about the shoulda coulda woulda's that we never actually get started doing anything meaingful.
Start with the existing system then. If you think we can do better, prove it. Bring that same level of optimism into improving existing standards of medical care -- then come back and we'll talk about expanding those systems.
> we never actually get started doing anything meaingful.
I think this regularly gets pulled out as a justification for expanding systems that have significant problems, and critics are supposed to take it at face value that we're all going to earnestly try to do better this time. But without something more concrete behind it, it's just talk, and talk is cheap. What often ends up happening is the same negative outcomes are expanded, and then the process repeats with the exact same line -- again and again and again.
So let's all get together and fix at least a few of the things that are already broken, and then maybe I'll believe you that we can all band together and build something new. But this kind of optimism divorced from practical action doesn't actually address concerns and doesn't actually improve existing or future standards.
I'm not saying everything needs to be perfect before we do anything new, of course that's never going to be the case. But I am saying that if all of our existing systems are garbage, the words "we must try" need to be backed up with something much more tangible than anyone is providing in this comments section.
That is exactly what this original article is about.
The article, and me in these comments, have been proposing to do exactly this. Bring back much of the old system that has been sustematically dismantled over the last 70 years, with improvements of course.
I think you are missing a lot of the context here.
That is not at all what I meant by "existing system" :)
"Start with the existing system" means "prove the US is capable of imprisoning people without regularly subjecting them to horrible conditions." That we used to run an even more expansive prison system doesn't mean that bringing that prison system back under the guise of medical care wouldn't be an expansion of the current system. The old system was torn down for a reason, and reintroducing it now would be an expansion of the current prison system.
We very deliberately systematically dismantled the old system of asylums because they were incredibly abusive. And unfortunately, the remnants of that system are still abusive today. My point is that "we have a long way to go but we have to try" doesn't mean very much when it's just words. Advocates for asylums should start by addressing some of the abuses that are still rampant today in the systems that are operating right now -- let's see some evidence that re-expanding the prison system won't be a horrible disaster for human rights, let's see some actual improvements to prisons that already exist today to back up that optimism.
----
The risk behind untested optimism is that every expansion of the prison system can be excused this way. Any abuse that results in cutting back on incarceration becomes temporary and it's assumed that "getting back to normal" and reintroducing those systems is the normal desired state, rather than a dangerous step backwards towards a system that was consciously rejected for good reason. And advocates that argue (deliberately or not) for expanding and reintroducing systems of abuse can just keep saying "we'll do better this time, this time we'll have reforms."
Nah. Let's see some of those reforms in existing prisons as they exist now for regular prisoners. Let's see standards rise for the prisoners with and without mental issues that we already have in jail today. Then we'll talk about whether expanding from what we have today is wise.
An institutional system can be built with cross-checks, inspections, corruption fighting mechanisms, etc. By this I mean actual, independent, not powerless, not perfunctory, corruption-fighting, enforceable, etc. As opposed to the usual such cross-checks around here. This is a far broader issue that just mental health but simply (not) doing mental health on the street isn't a great solution.
It can be but not within capitalism. Even if it’s the Best Government Program Ever, eventually it will become public/private, and eventually private. And it will get worse and worse the entire time. Once it’s fully private then it will be incentivized to put people there (if it wasn’t already), and those interred will be used for labor in the worst and likely most potential ways. It’s reinventing prisons.
Which institutional system out there, worldwide, is a model of cross-checks, effective powerful independent oversight, corruption fighting, etc - enforcing not just lack of corruption (not just financial) but also efficiency in accomplishing its mission? Anyone? Anyone?
Some institutions used to have great reputation but I don't know that they were all that efficient. (UK Police, French electricity company). But for both of these I don't feel that it was because of good independent oversight anyway.
Might as well propose that we eat the homeless and mentally ill. Then we can complete the Jonathan Swift proposal and go back to the real world.
It then becomes a question of preventing harm. Releasing the individual back onto the street seems like a recipe to have the same harm occur again. Putting a crazy person in jail seems harmful as well. Which is where your parent commenter's suggestion comes in...
We (as in Western Civilization living in post-Enlightenment liberalism) can't purport to respect human dignity and self-determination and also criminalize homelessness. And that's what jail is, criminalization. There is no "non-criminal" jail. In the United States, you can't be criminalized without due process, because fundamentally, a basic western human right is the right to personal dignity and autonomy.
Criminal recidivism is a problem. Some homeless or mentally ill people will be recidivist criminals. They should be punished for their crime after being afforded due process and any defenses thereto (e.g. lack of mental capacity). There are ways to handle criminal recidivism (in CA, famously, there's the "three-strikes" rule against multi-time felons). Apart from hardcore criminal-justice reformers, nobody disagrees with the idea of punishing crime according to the nature of the crime and increasing punishment for recidivism.
Being homeless is not a crime. Nor is it a crime to have mental illness. There are ample failures (drug war, lack of safety net, unwillingness to regulate predatory housing/investment, lack of accessible mental healthcare, social stigma, etc.) that cause homelessness/mental illness. All of which are indictments against society at large. It is anathema to a free, liberal culture to cause the problem and then punish it criminally.
To say that society only intervenes when a crime is committed is reductionist and wrong. There are plenty of civil remedies that restrain conduct (e.g. an "injunction"). More broadly, the government restrains conduct all the time for non-criminal matters (taxation, zoning permits, most financial or environmental regulation, intellectual property laws). Different efforts to restrain activity have different methods of enforcement. Including involuntary civil commitment. But for the reasons mentioned above regarding due process and personal autonomy, only crime is enforced by jail time.
We cannot claim to be a free, law-abiding, liberal democracy rooted in Western ideals and at the same time carte blanche suggest that "jail" is a categorical solution to homelessness and mental illness, as the parent commenter suggested. The type of thinking that the parent commenter proposed is anti-democratic, anti-western, and candidly, fascist. There are plenty of places people can move to if they want to live in that type of society, but none of them claim to be Western in design.
Second, assuming you're genuinely curious and not simply trying to spread misinformation my answer would be to greatly reduce inequality. In my corner of the world housing has exploded in price. Healthcare is also very expensive. I don't see "hordes of drug addicts" I see Hoovervilles. For some reason we're not moved to help the destitute like we once were. Perhaps it's because we view them as "drug addicted zombies." So much for "love thy neighbor."
>… my answer would be to greatly reduce inequality
We’ve been screaming the same tune for over a decade at this point. Equality is a problem but it’s a parallel issue. Doing the same policies, but louder, is not a good faith proposal because it’s just repetition of what doesn’t work. Many, and indeed I would posit most, do not want your or my help to live as a “contributing member of society”. Some are so far gone they’re not in the position to even make a choice.
Perhaps I've been "screaming the tune" for a decade but in that time the cost of housing has gone up dramatically. In 2009 I rented a 2-br apartment in Capitol Hill for $1,600 -- parking included. In 2019 I rented a studio apartment in the same neighborhood for the same -- parking not included. I can produce examples like this all day.
My point is, we haven't successfully tackled the problem of inequality and affordability. In my opinion, we must tackle the root problem if we hope to resolve the issue long term. We can do that _and_ address the symptoms in parallel. However if I had to bet, my money is on housing continuing it's inexorable rise over the next decade, pushing further people into destitution.
I've tried to respond in "good faith." Your turn.
And then there's the huge sub-problem of people who are chronically homeless, drug-addicted, and visible.
Large efforts at simply improving access to housing are likely to make a large dent in the larger homelessness problem, but may not be effective in addressing people with long-standing drug addiction and behavioral disorders. Many/most have behaviors that are incompatible with conventional housing.
The solution for this subgroup is going to be a lot more complicated.
I agree with you. There is more than one piece to the puzzle. We seem to agree that housing is one of the bigger pieces, though. So let's start there and make some progress for a change. Let's not throw our hands up, like some in this thread, and say we've exhausted this approach and it's time for the stick.
For the rest, we'll have to go case-by-case. For the most recalcitrant, anti-social cases we may need the stick in the end. Hopefully by that point we can say the system isn't pathological. Regardless, I suspect the cases on that end of the spectrum will be less "homeless" and more "criminal."
These people we’re talking about will all be dead by the time any of yours or my pet ideas to increase housing supply come to fruition. And yet, in the here and now, there’s a continuing escalation of health and safety issues that, again, don’t go away if rents suddenly drop.
I've explained what I believe to be the root of the problem. You have not. I've explained some ways we might ameliorate the problem. You have not.
It's difficult to have a conversation when the interlocutor won't state their positions and take a stand. Even more so when they accuse you of "screaming" and acting in "bad faith."
I'm left to infer what you're thinking. I imagine it's that inequality is not linked to the rise in homelessness. (I disagree.) That people are more susceptible to drug addiction than before. (I'm very skeptical.) And that if we punish people more forcefully the problem will be resolved. (I doubt it, but that's not to say we can't protect our public spaces more vigerously.)
If I pegged you wrong, I apologize and look forward to being corrected. If not, then let's agree to disagree.
> That people are more susceptible to drug addiction than before.
Maybe somewhat; but a bigger part of it is that what was a problem spread throughout the US was successfully exported by the rest of the country to a few west coast cities.
> And that if we punish people more forcefully the problem will be resolved.
No, I don't think anyone is saying that. But adding housing isn't enough.
Homeless shelters successfully use inability to stop using drugs during length of stay as a predictor of violent, antisocial, and destructive behavior. You can't just place these people in housing units without a lot more scaffolding, support, and treatment.
"Housing first" works very well for 85%+ of homeless people, but treating this like it's one homogenous problem isn't going to be successful. If you try to just cram the rest into housing, they're going to still end up disrupting streets and causing property damage.
> protect our public spaces more vigerously.
Chasing the chronically homeless and ill from place to place isn't what I want. That game of musical chairs is what we do now.
Yes. There. Is.
> The past 20 years of the "compassion" approach
According to research, the problem is rising housing prices, not compassion. Human rights are also not compassion. It's sick how trendy it is to disdain compassion, human rights, and any other good.
You seem like more of a danger than the many unhoused people I've encountered -- including people I talked to last night and this afternoon, people I see every day. They aren't talking about locking up everyone like you - which I personally think would be a better step for society. (Don't worry; unlike you I don't think I should have the power to lock up people because of my personal feelings.)
You may laugh it off, but that shows the reason behind your proposal. You have more power than they do, so if you don't like them you abuse them. They same goes for the WSJ.
While this might be true for the homeless population as a whole, I suspect the parent is talking about the people with mental illness and/or substance abuse problems. Making rent 20% cheaper or whatever isn't going to magically make them get better.
Honestly we don't have to intellectualize this very much. A child can understand this. If housing is more expensive it will be harder for people to afford it! And people who can't afford housing become homeless!
Jails need to be supportive places where a person actually has the opportunity to grow and experience some dignity.
Facilities for the profoundly disabled need to be appropriately funded and there needs to be more room to those need.
Facilities for those experiencing mental health crises need more space and resources so they can actually get in in a timely manner and spend the time they need.
Quality of care needs to be improved across the board.
Then you can start talking about expanding to people who are having lots of trouble taking care of basic life necessities either temporarily or long term.
A lot of people really do just need a time when their basic needs are met with some good life advice provided to reset and rebuild themselves.
But the state doing it in the past has turned into minimizing costs and incredibly inhumane treatment of people least capable of advocating for themselves.
It's nonsensical to say we should bring back asylums and then not seriously consider what asylums were at the time. Women who tried to fight for their right to vote were put in asylums and raped.
No you don't. Nobody is advocating for that. Nobody is saying we should follow the same broken standards that led to locking up people for protesting, or that we should allow abuse and rape.
Do you not think there is any middle ground between raping protestors and letting people with violent schizophrenia live in a tent on the street?
Not too long ago, BDSM was considered a mental illness. We'not talking the 1960s either.. this was 2010 when the DSM-4 had BDSM and similar removed.
Prior to 1980, homosexuality was also in the DSM-4.
The trend is obvious and troublesome: this is mainly a list of consensual actions that were listed as "mental health problems" and therefore could be treated against the will of the person. And it's easier to dismiss a 'sick' person since they're obviously out of their mind.
So yes, this is something you definitely will have if the asylum system is recreated and/or reformed. Person making different lifestyle choices others don't like? Committed, with no real say or due process.
There are real people getting assaulted and murdered by the mentally ill right now. Not to mention the mentally ill themselves who are subject to violence on the streets and living in squalor. These are actual problems that are really happening and you're saying we shouldn't do anything to address them because of hypothetical problems you that you think might happen and that we could easily be aware of and prevent?
Just look at what's happening right now with them violating hippa to attack women trying to survive miscarriages...
Still, we have to do something about the homeless problem. These handful of people ruin millions of peoples lives.
Trump and DeSantis are individuals and their political views can't be reduced to a single scale running from "good" to "bad". They have different approaches to politics and they have different areas that they care about and they approach their political goals using different strategies.
They're both bad candidates, but they're bad in sometimes different ways. And there are many, many issues where DeSantis is better than Trump (although that's not saying much, and it's not saying that DeSantis is good on those issues). LGBTQ+ discrimination in specific though is an area where DeSantis is worse.
Are you asking whether rights people enjoyed for decades can be rolled back? You can't think of a single instance of that happening?
What’s the point here? We should never do anything if even one person can come up with some possible hypothetical scenario where it turns out badly?
Instead, how about we don't force that choice on people? How about we offer the option "don't lock up gay people" and also, "don't let mentally ill people murder anyone"? Call me a crazy idealist if you must, but I really think we just might be able to do both things.
Yes. But there is no easy solution. History shows that anything that involves locking up people because they might commit a crime will result in innocent people being locked up and abused.
The only safe choice is to oppose every proposal and offer nothing as an alternative.
I'm pointing out that you must absolutely contend with the fact that marginalized people have historically been labeled mentally ill when they fight for equality, and that asylums have historically been used as a tool for this purpose. If your concern is to address homeless insane people, one of the major causes of insanity is being homeless for more than a few months, and yet our homeless shelters are still under-resourced and we are still creating more homeless people by seeing housing as an investment that must always grow, pricing out more and more people.
If anything, I am pointing out we must address the "false positive" issue, where the population of people who are under threat of being institutionalized as insane even though they are just a marginalized person reasonably reacting to their own oppression might be greater than the insane homeless we want to address. And that "we just won't do that because regulation" is a straight up delusional belief, with zero basis in actual reality, and is more or less saying you hate homeless people more than you care about marginalized people losing their rights.
And I am pointing out that all people, marginalized or not, are currently subject to violence and harassment by the untreated mentally ill, right now. Not historically, currently.
If one party starts telling voters that they care more about hypothetical inconveniences for marginalized people than they do about people getting murdered right now, that party is not going to be in any kind of power for long and they will have no opportunity to protect anyone's rights.
The only reason why the rape of women in asylums is historical is because we no longer have asylums. If you want to bring back asylums, justify how you're not going to also be bringing back raping women in them.
Yes. A young woman was recently locked up for 90 days for terminating a pregnancy because she did not have access to legal abortion. There are people who basically want 'white sharia'.
I'm sick of the civic rainbow-religion. Get those flags and the moral authoritarianism out of my face. But let us not forget there really are people who think two guys shouldn't be able to hold hands in public or fool around in private.
I think we all do see such a middle ground, but think that it's really difficult to hit from a due process point of view. This is a parallel track, from the criminal justice system, to take away peoples' autonomy and rights to choose what happens to their bodies.
E.g. maybe we should be focusing on putting real treatment in jails (which tends to be pretty barbaric and ineffective at this point) and using the normal criminal justice system.
Yeah, how about full-service gas stations and Doowop hits too?
Even if the doctors themselves are moral, what prevents politicians from putting their thumb on the scale? We are already seeing them override physicians on gender affirming care.
What prevents politicians of finding a small number of immoral doctors who are willing to rubber stamp whatever they want?
Also it’s not uncommon to discourage procedures for minors until they are able to lawfully consent. So your example is muddy.
What we had is possible, it did happen. Why? What was the system of alignments and incentives that led to that being the case, and how are we different now?
I do think that if you want to bring back asylums, a place to lock away people who are too expensive or are otherwise uneconomical to treat, you must have an answer.
Talking about taxation in America is a political death sentence. Privatization of public services is still extremely rampant. How are you going to get well run asylums if you can't tax or you have a for-profit model?
If you want nice things, we have to be getting less corrupt as a country, not more corrupt, and we are most definitely getting more corrupt. I absolutely do not want asylums as long as we are inching towards literal oligarchy, and we definitely are inching closer to it than farther away. Our supreme court justices openly take bribes, and our representatives think it's ethically okay to trade stocks. Our politicians are choosing to carve up districts to keep themselves in power, and some want to absolve the idea of voting altogether and just choose federal candidates from state legislatures.
Asylums are running when we can't even walk. The post office was in the process of being dismantled to create pretext to steal an election and you think we can run an asylum?
Do you really want an asylum in the context of Ron DeSantis's Florida and GOP rhetoric against trans people? That seems like a bad mix.
Those that fail to learn from history are doomed to repeat it.
Asylums are where people are treated, as opposed to the streets where they're a threat to themselves and everyone around them.
From here[1]:
> What happens if the respondent isn’t compliant with the treatment order?
> It’s up to the judge but the idea is that non-compliance with a court order equates to contempt of court and is punishable by jail time. This is where the “teeth” or consequences are introduced for someone refusing to comply with the treatment plan. However, we have found that many counties do not enforce treatment orders with jail time.
We had, in our most respected medical facilities, numerous women subjected to extremely painful ovarian harvesting with no pain relief and it turns out a nurse was stealing pain medication from the patients for YEARS. You cannot seriously suggest bringing back yet another widely abused institution when our current institutions already abuse people to a horrific, systemic extent, as if it will solve anything.
If someone is proposing forced asylums you have got to grapple with the fact that Florida legislature considers being transgender a mental disorder and that Florida is fully willing to try and weaponize social services and child protective services to attack families with transgender members. You can't just gloss over that, you have to understand how a state like Florida will immediately try to weaponize an expanded system of forced asylums.
"We'll just have strong standards that prevent abuse" -- how? A nontrivial number of states right now are actively trying to use medical standards to oppress or eliminate a minority group. I'm sure Texas is going to have great standards on when the State can lock someone in an asylum. /s
Like you said, prison exists. And I will happily advocate for prison reforms within the existing legal system that allow for better rehabilitation of prisoners, particularly better rehabilitation for prisoners who suffer from mental disabilities or illnesses. Prisoners should have more access to mental health services, and prisons should be focused on treating and caring for prisoners who are struggling with mental health issues. And of course, prosecution already exists today, so prison reform changes nothing about prosecution, it would merely improve conditions for people forced into that system who have mental disabilities. Call it what it is -- prison, and then lets make prisons better. Sure, I'm on board.
But wait. Is that what people are calling for, even in this thread? People here are advocating that the government should have the ability to forcibly commit someone to an asylum. Well, wait a second, don't they already have that ability? What ability are workers currently lacking? They can forcibly commit someone to a prison once they've committed a crime and have been prosecuted. That system already exists, we have sentencing for crimes. So what do they want?
The fact that people are talking primarily about needing the ability to forcibly commit people indicates that they don't believe that police or judges or the legal system has that ability right now. They are arguing that current abilities to imprison people are not enough. They believe the State should have more power to forcibly imprison people than it currently does and that under certain situations the State should have the ability to expand prison sentences, possibly even indefinitely.
Otherwise they'd just be talking about prison reform and this wouldn't be a debate at all. Nobody is against prison reform[0].
----
[0]: Well, okay, many many people are against prison reform, but nobody who is worth paying attention to when they talk about justice or human rights or care for the mentally ill is against prison reform.
The state already has the ability to forcibly confine people. We just think that some people would do better in a hospital than a prison.
And given the state of prisons in the US, I know what that "hospital" would end up looking like. And I think it's kind of weird and very vaguely gross to try and distinguish. There really aren't many reforms or programs for an asylum that aren't applicable to existing prisons -- normal prisoners deserve mental health services.
That people so intuitively understand that prisons are horrible places for people with mental disabilities should not spark you to try and create Prison 2.0 Deluxe Hospital Edition, it should spark you to try and make Prison 1.0 less horrible for everyone.
It's a classic case of perfect being the enemy of good, and it's a major reason why the USA has problems like this, because of it's vetocracy structure.
IMO the first step to prison type sweden would probably be getting rid of the drug war and dismantling the DEA, much of the 'load' comes from that.
On one hand I agree that it would be a lot easier initially to sell the idea; on the other hand the public sentiment around prisons as they exist today and the unwillingness to treat prison residents as if they are human beings is a fundamental social problem that will corrupt attempts to build compassionate and helpful asylums.
I don't believe there's a shortcut; our prisons are horrible in part because society tolerates that. They will also tolerate abuse in mental hospitals, they will also very quickly dehumanize people who are committed to mental institutions. And very quickly you will find yourself in the position of needing to argue for basic human rights inside mental institutions and realizing that the same people who are antagonistic to prison reform are also going to be antagonistic to treating the mentally ill with dignity and respect.
That you feel that you can't really effectively argue for general prison reform to the general public is the canary in the coal mine. Your instincts are correct, you do not live in a society that cares about the rights of prisoners. Attempting to trick that society into caring about some of those rights by renaming prisons to hospitals... it's not going to work. The same people will vote and will have the same attitudes about segments of society that they would prefer please go exist someplace else where they can be ignored.
It's just going to be prison 1.0 with a different name on it. If you can't convince people to care about prison 1.0, you also will not have a defense when those same people stop caring about prison 2.0 for the same reasons.
Honestly, if anything having a different name on it will make it easier for the general public to ignore abuses in both asylums and regular prisons. The sentiment will be that asylums are "nice" so they're obviously caring for the sick people who don't know better, and mental health in prisons isn't a problem, those people go to asylums. And since asylums are nice, why do we have to wait for people to commit crimes? It's not like we're sending them to prison. And on and on...
I just don't think there's a marketing trick that can be done to get around that problem; it's reinforcing delusions people have about the justice system rather than correcting them. We have to actually do the work to change social views on prison.
And I think the distinction itself is kind of unhelpful for that effort. To be very clear, mental institutions and asylums are prisons. If saying that out loud rubs people the wrong way, it's because we know deep down that our current prisons are awful places and we all (myself included) desperately want to figure out some excuse to use so we can say that sympathetic human beings don't go there. Telling the general public "they don't deserve to be in prison, they deserve to be in a hospital" is in many ways just allowing people to feel less bad about the people who are in prison, it's a way to allow the general public to continue clinging to the idea that prison isn't about rehabilitation or treatment or safety. It's a way to allow the general public to shrug when people are sent to prisons because "it's just a hospital." But calling prisons a different word doesn't make them not prisons, it just makes us feel better about putting people into them.
do you have any sources for the occurrence of such events in the latter part of the 20th century?
Rates of depression in US states are associated with income inequality (after adjusting for income, proportion of population with a college degree and proportion over 65). The more unequal the state, the higher the prevalence of depression."
(https://equalitytrust.org.uk/health)
If you want to actually address the problem you'd look at inequality, and all the many problems that stem from it. But this is the WSJ, so I guess they prefer to throw poor people into jail, err, asylums, when they been broken by the current system and have no economic value.
If you are going to fund an asylum system well enough to be effective, you could fund our current system. If you are not going to fund it, you are literally reproducing the cycle that resulted in underfunded, abusive and hidden asylums of the 19th and 20th centuries.
This is already happening. Compelled vaccination is completely different than a mentally disturbed member of our society roaming the streets unhinged. I have been party to several title 36[1] cases and it's very, very difficult to get dangerous people "petitioned". It requires coordination between disparate agencies like hospitals, Fire/EMS, Police, community mental health orgs, etc. None of them share a database.
Once they are found to be incapable of living on their own, what do we do with them? Jail? Hospital? Half-way house/Assisted Living?
I will tell you... They end up back on the streets and it isn't pretty. The underbelly of every American city is a nasty, grimy, horrific place. I need to retire.
Those decisions still left much room for coerced treatment, so it's not clear how disastrous they were. Most if not all states and cities ended up with additional legislation, caselaw, and normative policies that made coerced treatment (including outpatient treatment) much more difficult.
This is the CDC site on the history of vaccine incidents: https://www.cdc.gov/vaccinesafety/concerns/concerns-history....
Bad things can and do happen and it doesn’t do any good to pretend they don’t.
Of course the reward is far worth the risk with modern science, but some people are still afraid of shit like this.
1. https://www.mercurynews.com/2023/07/02/this-should-be-a-wake...
As it is, we can't seem to staff health care jobs adequately and we think we can just magic up the workers who would take these demanding jobs. It's not even about funding. You can pay people insane wages but if they burn out quickly or just flat out refuse the working conditions you're stuck.
Asylums in the post were often horrid places of torture and severe lack of productive treatment. (Here I define productive treatment, as treatment tailored for the patient with an aim of improving their quality fo life and their ability to cope. It might very well not be able to make the patient able to function in society but it can help give them a better life)
We have this in a different form now in prisons. Due to lack of universal healthcare and for-profit prisons and "what the hell todo"
Prisons are today's asylums, and it has a severe lack of productive treatment.
Good, appropriate care in a safe environment, for both the patient, health workers and society. This works for the majority of cases.
Then you have a small group of patients who are downright dangerous for all. They can either be kept in a mental health hospital and drugged into a calmer state (not ideal), or be kept in prison or prison like surroundings (not ideal). For them we do not yet have an ideal model of treatment that does not impose a severe treath to personell.
1) Outlaw vagrancy, and arrest people for vagrancy, the crime specifically being living on the street instead of paying for their own upkeep, but the important part is...
2) They can get their freedom quickly by working some minimum wage job, provided by the city, like cleaning the highways or picking up trash, for a week. Then when they're released, they can still work that job, or they can get out of dodge.
This is a clumsy proposal and not fully thought through -- but there can be some mechanism that lets people who aren't totally deranged get themselves quickly released while directing the others to treatment.
An obvious criticism of this is, it's not hard to come up with counterfactuals. What if somebody is homeless with their family, and they get arrested for vagrancy. Now their kids are separated from them. Then what? What if they have a dog?
But aside from that, getting these people help apparently requires forcing them into custody. I don't want the more functional people, or people parking their RVs in the wrong place, to get swept up in that.
If you're forced to live on the street because you can't afford any kind of housing, you're just going to get arrested and forced into a minimum wage job where you still can't afford housing. Then you're still not affording housing, aren't you now basically enslaved if you're just going to get arrested again and forced to work a minimum wage job?
About 53 percent of the sheltered homeless had formal labor market earnings in the year they were observed as homeless, and the authors’ find that 40.4 percent of the unsheltered population had at least some formal employment in the year they were observed as homeless.
This finding contrasts with stereotypes of people experiencing homelessness as too lazy to work or incapable of doing so.
None of that is to say I don't think it's probably the right answer, rather that I just don't see it happening in modern America.
"Between 2008 and 2019, the percentage of adolescents (ages 12 to 17) that reported having experienced at least one major depressive episode in the past year increased nearly 90 percent, from 8.3 percent in 2008 to 15.7 percent in 2019"
As m463 highlights, 'But later state mental illness funding was cut.'
Does the cut in funding correlate with the rise in problems?
Author David M. Oshinsky is per Wikipedia an American historian, director of the Division of Medical Humanities at NYU School of Medicine[1] and a professor in the Department of History at New York University.
This has been used in the past to silence rape victims, and it will be used again to silence rape victims.
The State should not have this power.
Many people in business arguably belong in an asylum - how about the wealthiest person in the world? how about some WSJ op-ed writers? crypto bros? some SV VCs? - and mentally unstable people with power are far more threat than the person on the subway.
I don't believe that so many have had so many extreme experiences as they report, though of course I don't know you personally.
Okay but if we need to fear the opinion of the WSJ, we're already screwed. What's stopping them from advocating for locking up people they don't like right now? How does the existence of asylums suddenly turn this frightening power of mind-control that you seem to imply that the WSJ has into a real threat?
Walking up to a brick wall is easy, walking through the brick wall is hard (and painful). And yet I walk up to brick walls all the time, and don't fear that I'll accidentally go too far.
Washington state has what is called ITA (involuntary treatment act) which is used for holding people in mental health facilities temporarily. These people are placed there after a DCR (designated crisis responder) performs an evaluation on the person.
I work in an ED in a busy city hospital. We have a constant stream of psych patients coming in. Not all of them end up on ITA. Some times they just need to go through a 72 hr hold in the ED and detox and are fine to be released. Other pts coming in every week , they’re too unstable to live in a shelter but not enough of a danger to themselves or others to be sent to a mental health facility.
The social workers at the hospital are the ones who make these decisions to place pts on holds. They are not tyrants with power trips. These are people who have Masters in psychology and licensed in the state. They’re incredibly empathetic people working a job that is massively underpaid compared to their private sector colleagues.
Some of these pts are absolutely unable to care for themselves but again can’t get into shelters because they are behaviorally nondirectable so their only recourse is to live on the streets.
Pts get ITA and sent off to facilities but after 30 days they’re released back on to the street only to end up in crisis again and back in the ED to start the process again. We have one regular pt who cuts himself every time he gets released. His legs and arms are covered in scars. He isn’t capable of taking care of himself but he doesn’t stay sober enough to live in a shelter so he’s in the ED every week until something bad enough happens that he gets ITA and sent to a facility again, rinse repeat. There’s no where for most of these people. There is no long term facility for people who are not able to care for themselves and function in society.
When I worked at homeless shelters before the hospital I’m at it was a mess. There’s no help for people who want to get sober. You’re thrown into a barracks style room mixed in with sex offenders, users, elderly, mentally ill, there’s no separation and there’s no services to help people so you see them relapsing constantly. There’s usually encampments outside the shelters so those trying to get clean can’t even go outside without being triggered by the surrounding people using openly and selling to those living in the shelters. It’s really hard to be sober and get your shit together living in a shelter.
This is just a scratch of the surface. It’s so much more complex and nuanced than what you think.
If there was an easy answer to poverty/mental illness, then they would hardly be perennial issues of humanity; they'd have been solved long ago.
What should happen is they should be expelled from society. Expulsion was very common in historical societies. The famous version of this is leper colonies. The land of thr country belongs to them, so designate a place for them to live in isolation except for volunteers that wish to visit them and offer aid/help.
People should be asked that in the event they are deemed by professionals to be incapable of making their own decisions that they delegate the power of decision making on their behalf to the courts or society.
This is a pervasive issue, even things like not wanting to be dependent on tech for day to day survival is a person's right. Compelling a person to do anything means you have deprived them of liberty and subjugated them, and to do that, having a good and legitimate reason is not enough, you also need authority.
In communist governments for example, people are subjucts of the state and the state assumes authority even over what people belief. But in the US at least, the government that derives all its power and authority from the governed has not been granted such unlimited authority over law abiding citizens, or authority to pass laws to manipulate peoples bodies, regulate their beliefs and convictions or imprison them when they have not broken a law "for their own well being and without their prior consent. The people did not consent to have their wellbeing and safety taken care of against their will. If insane people, unvaccinated people, naked people and other people are considered to place a burden to society or to cause harm in the future, simply forbid them from coming into contact with society and only enforce complelled measures when they persistently refuse to comply.
It’s very difficult to shake the idea that you’re trolling.
America was built by people that kept migrating to the west to live out their ways or as punishment. Same with australia. The only thing new in my suggestion is having it be a consensual option.
The section on therapy and nihilation comprises just a few paragraphs, but the general gist is this. Therapy prevents immigrations from reality and nihilation prevents contamination of reality. They are, of course, both machines of universe maintenance. However just because they share a telos, doesn't mean there isn't much of a difference. There is a vast difference between the experience of being subjected to either therapy or nihilation depending on the social and material particulars of each.
1. Berger, P.L. and Luckmann, T. (1966) The Social Construction of Reality: A Treatise in the Sociology of Knowledge. Doubleday & Company, New York.
That's why we have human rights - people are free to do what they want, without giving a f- if you like it or not. You are free to do what you want without giving a f- if I like it or not. Yes, there are limits where we harm others.
Let's be honest: People just don't like other people who lack housing and look dirty; people are scared of what's different; the rest is mostly rationalization for oppression.
What part of what I said was an "internet theory" and exactly what are my other theories? Do you just mean ideas you merely react to at a surface level instead if attempting any level of undersranding or discourse??
> That's why we have human rights
No, the only reason there are human rights is because people are human.
> people are free to do what they want, without giving a f- if you like it or not
What does this even mean? Are you saying society should be able to lock up arbitrary people for no reason or do you not know this already happens? Asylums are the institutuions, forced incarceration when you are considered insane is a thing, as are many laws that jail people who are not harming others on suspicion that they will cause harm or are behaving undesirably.
> Yes, there are limits where we harm others.
Or yourself, that's what the entire discussion here is about in case you missed it.
> Let's be honest: People just don't like other people who lack housing and look dirty; people are scared of what's different; the rest is mostly rationalization for oppression.
And my "internet theory" as you put it, instead of opression, it allows freedom for the would be oppressed to chase the life they choose. Have you heard of nudist colonies? That's the idea except you cannot rejoin mainstream society so long as you refuse to conform to its ways, but you should not have similar obligations either like taxation. If you are in these expelled communities like the insane, unvaccinated, etc... you still get to vote, access the internet and do just about anything so long as you stick to your physical isolation. It decriminalizes many victimless crimes.
And mainstream/majority society will decide like it already is doing.
Then.....
> In communist governments for example, people are subjucts of the state and the state assumes authority even over what people belief.
That is a false dichotomy.
Who does a person belong too?
We are nothing without our communities. Naked apes at the mercy of fate.
It is our communities that make us able to survive. Our families, neighbors, friends, foes, we are all in it together. Bonds of love and mutual obligation
Supporting each other, meeting the needs of others and having our needs met does not mean we live in North Korea
Mutual aid is not the end of individual liberty. It is the engine that makes it possible
Their Maker if you believe in one (read declaration of independence to see similar views around foundation of America), or no one I suppose if you are an atheist. This is why the government shouldn't tell you what to believe in.
> We are nothing without our communities. Naked apes at the mercy of fate.
You own your community/government in the US. Not the other way around. For example, conscientuous objection to participating in combat, for soldiers! (As government property as you get) is a thing because ultimately the government lacks authority over a person to override their beliefs or ways. The "community" as you put it only has authority over you over activities that affect it. My suggestion is to simply remove people from a community who refuse to play by its rules while allowing them to pursue their own ways.
> It is our communities that make us able to survive. Our families, neighbors, friends, foes, we are all in it together. Bonds of love and mutual obligation
Communities are consensual relationships not ones formed out of natural hierarchial authority over others. None of what you said here is relevant because the subject here is when people are being forced to do things against their will just because the majority wants it that way, making them lesser subjects and prisoners of the community instead of equal and consensual participants of it.
> Supporting each other, meeting the needs of others and having our needs met does not mean we live in North Korea
When your support jails people or makes it so that they can't function without conformance, it does indeed become opressive to them.
> Mutual aid is not the end of individual liberty. It is the engine that makes it possible
That's nice but what part of this topic is mutual aid?