I've had this conversation with many friends. Totally agree. They need to be good, well run with compassion and care of course. But we indeed need them.
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.
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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.
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...
The trades come to mind.
https://en.m.wikipedia.org/wiki/Deinstitutionalization_in_th...