
How Oregon ensnares mentally ill people charged with low-level crimes - joveian
https://www.oregonlive.com/expo/news/g66l-2019/01/a646cacb3c6955/costly-ineffective-cruel-how-oregon-ensnares-mentally-ill-people-charged-with-lowlevel-crimes.html
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phren0logy
I’m a psychiatrist, and I worked at Oregon State Hospital.

This article, like most articles about mental health, raises some important
issues while somehow managing to get lots of things wrong.

First off, the remodeling of Oregon State Hosital resulted in a net decrease
in beds. Another recent project to consolidate most of the inpatient
psychiatric beds in the center of Portland also resulted in fewer beds, but
let local hospitals divest themselves of inpatient units they never wanted
because they lose money. So, there are not many places for people with active
and severe mental illness to get inpatient treatment (which is, of course, not
the only way to get treatment, but can be a major one for people who are
incapable of recognizing they are ill).

Having worked in other states, it is my opinion that the crux of the problem
is that there are too few avenues to get people help when they need it but
don’t recognize the need. Because it’s so increadibly hard to get people
involuntarily hospitalized (which I recognize can be abused), we end up with
them being arrested instead. As noted above, involuntary hospitalization can
be abused, but when so many mentally ill people go untreated until they are
arrested it’s perhaps time to reconsider if things are working as intended.
Then, once someone is arrested, evaluated as needing to be restored to
competency for trial, and finally gets to the hospital, many of them decline
medication. For most of them, it’s implausible that their condition will
improve without it. So they have arrived at a point in their life where they
don’t know they are ill, have done something to get themselves arrested that’s
often related to their symptoms, and continue to decline treatment. I see it
as an unintended consequence of such strong protections on individual rights.

Of course those individual rights should be protected, but I would
respectfully suggest it’s time to reconsider where the lines are drawn. This
movement of the mentally ill from asylums (where they were often mistreated)
to jails and prisons has been dubbed “trans-institutionalization” if you want
to read more about it.

~~~
ColanR
It is a Big Deal to deny someone their autonomy, no matter which way you slice
it. I think we agree on that.

But, respectfully, I think that because it is such a big deal, imprisonment is
the proper escalation. It's necessary to maintain a sense of proportion, and
we need to avoid - at all costs (and I think that is where we diverge) - the
decrement of the right to autonomy. If we make it less of a Big Deal to revoke
that right, 'merely' hospitalizing them, we lose our respect for that
autonomy.

~~~
phren0logy
That’s the tact that Oregon has taken, and I can see the logic in it. But as a
doctor I find it more palletable to explicitly try to work in someone’s best
interest than to send them to jail/prison. I am obviously biased, but I have
seen hundreds of people get well and go on to live lives that they themselves
would identify as more rewarding. Deprivation is, and should continue to be a
very big deal. But when it becomes necessary, I’d rather that it be focused on
the best interest of a person who’s not in a position to recognize their own
circumstances.

Clearly it’s a value judgement and there’s no one right answer. It depends on
which of two bad options you find least offensive.

~~~
hirundo
> Psychiatry possesses an inherent capacity for abuse that is greater than in
> other areas of medicine. The diagnosis of mental disease can give the state
> license to detain persons against their will and insist upon therapy both in
> the interest of the detainee and in the broader interests of society. In
> addition, receiving a psychiatric diagnosis can in itself be regarded as
> oppressive. In a monolithic state, psychiatry can be used to bypass standard
> legal procedures for establishing guilt or innocence and allow political
> incarceration without the ordinary odium attaching to such political trials.

[https://en.wikipedia.org/wiki/Political_abuse_of_psychiatry_...](https://en.wikipedia.org/wiki/Political_abuse_of_psychiatry_in_the_Soviet_Union)

Is that "inherent capacity for abuse" overstated?

I'm less afraid of the corrupt psychiatrist than of the one sincerely
convinced that people who think like I do are sick.

~~~
phren0logy
It is real and relevant, and already accounted for in the concerts about
limiting personal liberty. The usual mechanism to address this is to require
more than one clinically trained person to agree, which holds them for a few
days until it can be heard in court and decided by a judge. This requires it
only illness but immediate danger to self or others. This has had the
unintended consequence of conflating mental illness with violence. Always
trade offs...

~~~
75dvtwin
WRT

> The usual mechanism to address this is to require more than one clinically
> trained person to agree, which holds them for a few days until it can be
> heard in court and decided by a judge.

It seems the above would only work (meaning that it would prevent abuse) if:

a) the 'clinically trained persons' affiliate with different political
fractions

b) there is no 'federal-level' oversight hammer that can strip them of their
credentials for testifying against the wants of the currently ruling political
fractions

c) The judiciary system overall is free from 'selective-outrage' ( Which is,
unfortunately, some would say, not the case for US, Canada, France, UK,
Australia, not even mentioning known oligarch/dictatorships countries out
there )

------
ordu
I'm not an american, and some points seem alien for me. Is it really bad to
jail mentally ill homeless man? He is homeless, he is mentally ill, he have
nowhere to go, he have no warm and soft bed to sleep, he need to eat, and have
no ability to find food. He is forced to break a law to steal a bottle of tea
to drink. Probably he is stealing his food to eat. The jail imprisonment can
solve the most of these problems for him. Moreover he would get medication,
which can make his mental life more comfortable. And it is good for a society:
he now gets his dinner legally without need to steal.

I agree, that $1k per day per patient for that is a way too much, and I see
_this_ as the problem. But while reading this article I've formed a suspicion
that article points to moral unacceptability of imprisonment of mentally ill.
It is unacceptable because it is amoral and to hell with all the attempts to
reason rationally. Is my suspicion is a right one?

~~~
behringer
US prisons are more like torture centers than a traditional rehabilitative
institution. If the prisoner doesn't behave just right, he could end up locked
in a small room 23 hours a day. He could end up assaulted and abused. He could
end up being taken advantage of.

In the US we have institutions for the mentally ill and he would be better off
there, but it's becoming increasingly more only for the wealthy to use.

~~~
creato
> US prisons are more like torture centers than a traditional rehabilitative
> institution. If the prisoner doesn't behave just right, he could end up
> locked in a small room 23 hours a day. He could end up assaulted and abused.
> He could end up being taken advantage of.

Is this really true? This seems to be a popular assessment but every now and
then I see first-hand accounts of people who went to jail/prison and my main
takeaway from them is that it's simply boring and nothing really happens, and
that the average joe is just going to go in, be bored, and get out.

There are definitely big stories/issues that come out every so often but they
seem to be the exception rather than the rule.

~~~
crimethought
LA county jails are dangerous especially if you aren’t white. Depending on the
unit, your pod will be ran by either a Hispanic or Black gang member who runs
the “program”.

I was arrested on a minor misdemeanor and thanks to the magic of corruption,
got thrown in jail for 35-days when my plea deal was 0.

I was in jail with convicted murderers, people on murder trial etc. I was
handcuffed to a man that was savgely beaten by gang members for a minor
offense involving a newspaper.

The process to goto court was insane — including dry runs where you basically
sit in a small cold holding room with up to 50 people from 6am to 5pm but are
never called to court. In that room, inmates had been murdered and yes they’re
cameras now but people cover them up for a fight.

This was my 1st arrest, for a dubious crime. I even called the police for
help, was unjustly arrested than put in jail with violent criminals and
violent deputies whose behavior has improved since the FBI installed video
cameras.

