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Comment by echelon | Hacker News Reader

> when they closed down all the mental institutions.

Why on earth did we do this?

I look back at period pieces - films showcasing the 40s, 50s, etc., and it seems like mental institutions would be a wonderful way to house these folks and keep them fed and warm.

I know there were abuses, but we have cameras now. And that's surely better than leaving them on the streets to freeze to death.

I can't imagine it would cost that much, and it would clean up the streets of drugs and homelessness. And reduce the tax on emergency services responding to calls.

I feel so bad for what we as a society do to these people. When my city closed down the local homeless shelter in midtown, the people on Reddit - supposedly leftists - cheered. I was so sad. These are the same people that call me fascist all the time for being a fiscal moderate and saying we shouldn't build subway to the suburbs. Being humanitarian would cost 1/10,000th of that.

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> Why on earth did we do this?

Much has been written about this, but from what little I know, they were abusive, and didn't do the job well. And were abused to keep sane people in.

I've heard that the advent of better drugs was also a factor. Prior to those drugs, there was no alternative other than commitment to mental facilities. The drugs gave the promise of a more manageable life - either by the patient or by their family.

What did we replace them with? Prisons.

About 20 years ago I saw a documentary about the use of prisons as a means to get mental health care. It explored the history that led to mental institutions getting shut down, and how prisons are treating the mentally ill. As crazy as it sounds, the prisons are doing a better job - even the inmates agree. Quite a few inmates said that the biggest problem they had was that they would be released from prison and not get access to the care they were receiving (including medications).

It wasn't trying to paint a rosy picture - they actually said this is, in one sense, an abuse of the prison system and that there needs to be a better way to treat them - but the consensus was "Definitely should not revert to the prior mental institutions!"

>I look back at period pieces - films showcasing the 40s, 50s, etc., and it seems like mental institutions would be a wonderful way to house these folks and keep them fed and warm

I'm reading this comment as if you had written:

"The TV show Hogan's Heroes makes being a prisoner of war sound like a jolly good time."

If you take the average person who doesn’t have a mental illness and has no relationship with anyone who does, the system we have is pretty well optimized for their needs.

We balance many difficult and inherently conflicting goals, such as:

1) minimizing treatment, which is expensive and does have bad side effects

2) sufficiently good access to treatment where it’s economical for prevention

3) fear of being wrongly hospitalized (error, political motivation, etc.)

4) sufficient ability to lock other people up for frightening or violent behavior in public

It’s a tough problem, but I think the tradeoffs are managed near optimally, granting that the rights and interests of the mentally ill don’t matter at all to most public officials or voters.

Except that those same people then complain about how many homeless people there are.

Reagan's destruction of the mental health system was really awful. The system needed improvement and more accountability, but we need it.

I had an adult step-brother too ill with schizophrenia to be cared for at home (he began making violent threats and stealing things, up to and including my mom's car), but under the current threshold for being compelled to take his medication. My mom (his step-mom; an attorney) spent years trying to find ways to get him help, but he bounced in and out of being homeless and ended up being murdered at about age 60 in a halfway house. Just a stupid, tragic waste of a life and all of the resources mis-allocated.

Sadly, it's just another example of how the US is penny-wise and pound-foolish when it comes to social services.

I also personally know the waste, stupidity, and cruelty of these situations. But I’ve come to the conclusion that the voters know what they want, and preventing these terrible outcomes is not worth the cost to them.

>> when they closed down all the mental institutions.

>Why on earth did we do this?

Supreme Court decision, O'Connor v. Donaldson.

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