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Working as a librarian gave me PTSD symptoms (latimes.com)
217 points by 80mph 34 days ago | hide | past | web | favorite | 272 comments



The kind of people who are giving the author PTSD aren't going to be helped by free housing, free money, or free anything other than free medical care, and in the extreme cases, institutionalization.

Since we find the idea of involuntarily committing psychiatric patients to be unpalatable these days, we have to either way until they commit a serious crime and go to prison, or live with them on our streets and in our libraries.

There are many homeless people who are not socially problematic, but that's not what this article is about. The problem people are incompatible with free housing, because they are violently unstable. They're schizophrenic, drug-dependent, or just plain violent.

All these responses about economic considerations or a lack of homeless support infrastructure are totally missing the real issue, which is that some people have such extreme mental illness or other social problem that they are incompatible with peaceful society, and it's not something than can be solved with housing and cash. That is a separate problem entirely.


>Since we find the idea of involuntarily committing psychiatric patients to be unpalatable these days

We closed the asylums, because the long-term detention of the mentally ill is costly and inhumane. We can do better than just warehousing people in pseudo-prisons. We completely failed to provide adequate support in the community for people with severe and enduring mental illness, which is why so many people are trapped in a cycle of homelessness and incarceration.

Most of these people aren't "incompatible with peaceful society", they just need help and can't get it. If any one factor is to blame, it's the systematic defunding of social work and community mental health. If your local library is full of mentally ill homeless people, the fundamental questions are why do these people have nowhere else to go? and why is nobody here who actually has the training to help these people?.


> Most of these people aren't "incompatible with peaceful society", they just need help and can't get it

Do you have any source that most of these people can't get it? With a father who outright refused any medical help unless basically forced on him, in a country where it's completely free, I can absolutely relate to the argument that not having involuntary psychatric treatment plays a big part here. And his mental state was only a minor part of his health issues.

It's not nice to be in stationary psychatric treatment. These are horrible places you want to leave as soon as possible. But it sometimes can't be helped.

I can even relate to the point that it's better for (some/most of) these people to live on the streets than in a psychatric facility, while it's probably worse for society as a whole.


I've known quite a few people who were suicidal who had a hard time getting care.

One 30-something women who was on medicaid, suicidal, history of opioid addiction and (I believe, based on her living with us for 1.5 years and my reading everything I could about psychiatric diagnosis) schizoaffective showed up at the hospital and got discharged 48 hours later.

She killed herself a month after that. She was unable to work, even unable to get up in the morning and smoke a cig sometimes even though she was addicted to tobacco.

A 50-something man I knew drank antifreeze, presented at the ER. Was discharged 48 hours later. His family wondered where he was in that time. People in the ER don't take suicide attempts seriously because they have a few "frequent fliers" who take a handful of pills every week.

He gets a referral to a psychiatrist two weeks later. Has to fill out his name and birthday 20 times, gets asked questions like that over and over again, has an argument with a nurse, is underwhelmed with the doctor... That night we get a call from his wife and they don't know where he is. We told her to call the police, she did, they kicked down the door to the garage and found he was hanging.


There's a world of difference between "having access to medical care" and "having access to appropriate care for a disorder that presents particular obstacles in accessing conventional care pathways". Access to care in the US is highly inconsistent, because there's a patchwork of providers and funders.

Effective care for people with severe and enduring mental illness needs to be patient-led but assertive - we're not going to lock you up unless it's genuinely in your best interests, but we're not going to let you slip through the cracks either. Compulsory inpatient treatment is a necessary last resort where people pose a clear and immediate risk, but it should not be the basis of care for severe and enduring mental illness.

The issues regarding involuntary treatment in the US are highly complex, but the evidence indicates that involuntary community treatment does not make a significant difference in clinical outcomes. Forcing people to attend appointments or take medication doesn't seem to result in any long-term benefit on aggregate. Some people do benefit (at least in the short term) from being treated against their will, but compulsion undermines the relationship of trust between care providers and service users and discourages people from engaging with care.

https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8...

https://en.wikipedia.org/wiki/Assertive_community_treatment

https://www.cochrane.org/CD004408/SCHIZ_compulsory-community...


> significant difference in clinical outcomes

But by removing these peiple from the streets nd the libraries, even if they are not cured themselves, we avoid a librarian -- a productive member of society -- from developing PTSD.


My (controversial?) opinion is that the civil commitment laws aren't good enough. A (mentally ill) person shouldn't have to become a danger to others or themselves before a serious conversation about involuntary commitment can be had.

And I acknowledge and fully accept that this is a very rough position to hold today. But, it is born out of over a decade of direct personal experience. It's come from watching the state of California continually fail to provide adequate support to my clinically diagnosed family member, to our family as people who care about this person, as well as failing to protect to public from him time and time again.


but we're also conveniently shielded from having to come up with actual good and humane solutions to the problems these people have. I don't think the benefits are worth the cost.

We have a long history of simply 'hiding' people who were inconvenient and/or problematic, where in many cases various forms of treatment have essentially solved the problem.

I personally remember a time where kids with AD(H)D were sent to 'special schools', lumped together with others who often had more severe problems, for example. I definitely think things got a bit better now that we found ways to keep these kids integrated in society.


There are a lot of conditions for which we don't have good answers. If you have something the world doesn't know how to fix, the reality is you aren't getting the help you need even in a good system. In the US, this gets compounded by systemic issues.


Can we? The severely mentally ill, those with willful medication noncompliace and/or violent psychotic episodes, what do you propose we do with them? It's well known that many of them lack the self-awareness to even realize they are ill. Some sort of involuntary commitment is necessary.

Frankly I believe the asylum would be a better place for many of them rather than taking dumps on the streets of San Francisco. Closing them was a mistake; rather what was needed was more oversight. It would be like shuttering all nursing homes and sending the elderly back onto the streets or into their children's homes, because the cheapest ones are run like deathbed holding warehouses. In fact they've all but reappeared, we just call them prisons today, or sometimes a long-term residential psychiatric care facility.

Historically the severely mentally ill were either put to death, or placed under the custody of their immediate relatives, with the family being punished if said ill person were to cause trouble in society. This is not really an option in modern society. The severely psychotic need inpatient care, and it should be an option. Today they're getting it in jail, this is not ideal.


I agree. The majority of homeless people I encounter in NYC are mentally ill. Many are drug or alcohol dependent. It's not uncommon at all to see someone having a shouting argument with themselves. Most reek of urine. This is not how a humane society deals with this issue.

It is also not safe. Although most homeless people in the city are non-violent, it's not uncommon to read about a delusional person slashing someone across the face with a knife or pushing someone in front of a moving train.

Involuntary commitment with compassionate care, properly funded with ethically-aligned incentives, is the most humane solution. Doctors should be the ones to recommend who among the patients is ready to reintegrate into society, and those individuals should receive an apartment and a job with some kind of state or federal work program to provide a routine, though they would of course be free to seek out alternatives.


Same issue with homeless population in Portland, Oregon. It's a very divisive hot topic right now with no easy solution.


Bi-polar can be treated with medication and people can often lead a normal life as a result.


Yes, but in particular I'm referring to the problem of the mentally ill not taking their medication.


I think schizophrenia is the much bigger problem regarding the homeless.


I’ve heard many times of bipolar people committing crime because they either decided to stop medicating (it does make you feel not good) or they lost them or something.

There is a point between individual freedom and public safety. We can’t just sigh and throw up our hands in the air.


In complete agreement. Consider also the historical uniqueness of public libraries: if they didn't already exist in the fabric of civic life, would we really have the political ability to build them? We have little imagination or desire to build civic institutions any more; we only know how to build commercial ones.


It's not just civic institutions. Manhattan would be illegal to build these days in Manhattan.

I'm glad that incapacity hasn't affected the whole world, yet. But it's seems to be spreading.


>Manhattan would be illegal to build these days in Manhattan

I don't really view that particularly to be a problem. Manhattan was already built in Manhattan, it doesn't need to be built there again. Now that it exists, it needs to be managed with the new problems that have arisen since the building of Manhattan. Problems change when you scale, things that were not a problem when you were growing are now a problem after you achieve massive success

"Do things that don't scale" is great advice for a growing startup, and for a very good reason. Because once you get to Manhattan size, you have to start doing things that do scale. If Manhattan hadn't changed its building codes, it would be unlivable today.


Nobody is really talking about building codes. Building a skyscraper without fire sprinklers is a bad idea, but requiring fire sprinklers is not a thing that prevents you from building skyscrapers. On the other hand, a rule restricting building height or imposing minimum parking requirements or the like does exactly that, and has no benefit other than to enrich the existing landlords when it prevents housing supply from responding to increased demand.


Probably not. It would be easy to paint public libraries as "socialist" which is a dirty word nowadays.


There was a window of time (roughly from the eighties until about 2016) when "socialist" wouldn't be used because it was perceived as outdated, too linked with the Cold War and Red Scare... so it would be painted as "entitlement" or "lack of personal responsibility": if you wanted to read, you should have bought your own damn books.

(I think the discourse is being revamped in light of the rise of democratic socialism in US politics)


> adequate support in the community for people with severe and enduring mental illness, which is why so many people are trapped in a cycle of homelessness and incarceration.

The level of "adequate support" needed for (some of) those people are much higher than what you're probably imagining

> they just need help and can't get it

And even when they get one day they just say "I'm not taking the meds anymore" and then what? It's back on the streets or homeless hostels.

Sure, they might not be aggressive per se, but that doesn't mean they are "compatible" with society.

> the fundamental questions are why do these people have nowhere else to go? and why is nobody here who actually has the training to help these people?

You're just pointing out problems without pointing up the solutions. And I'm afraid the best solution would be something much similar to what's described in your 1st paragraph.


>And even when they get one day they just say "I'm not taking the meds anymore" and then what? It's back on the streets or homeless hostels.

If someone goes off their meds, you don't just abandon them to the streets. You send a trained mental health nurse and/or social worker to talk to them, several times a day if necessary. If they don't want to engage, you work with them to build a relationship of trust. You work with that person to get them back on a suitable course of medication, or to help them manage their symptoms and manage their life while unmedicated. You provide supported housing and supported employment or work-related activity wherever it would prove beneficial. You keep working with them again and again and again unless you're damned certain that they're truly beyond help.

Of course that's expensive, but it's also remarkably good value for money compared to the alternative. The net difference between a borderline functional person and a completely dysfunctional person can exceed a million dollars per year in policing, incarceration, ER visits and other costs.

This model of community care isn't new and it's proven to work and to be cost effective. There are plenty of places in the world that don't rely on mass institutionalisation and have remarkably low rates of homelessness.


> You send a trained mental health nurse and/or social worker to talk to them, several times a day if necessary. If they don't want to engage, you work with them to build a relationship of trust. You work with that person to get them back on a suitable course of medication, or to help them manage their symptoms and manage their life while unmedicated.

Serious question, would you be willing to do that job? For what price? For how long?


If I were a trained mental health professional who had also been trained on emotional regulation capable of doing this job in a society where mental health professionals are equal to nurses and doctors I would definitely do this job for the salary equivalent to a nurse or a doctor. I’d be contributing to the greater good much more than my current position writing software that will never change/save lives.


The median physician salary is $217,000, and the average family doctor oversees a panel of 2,300 people, who see him or her about 20 minutes, two or three times a year.

There is not a sustainable system where workers pay taxes sufficient to afford a specially trained nurse or doctor for full time, personal care for everyone who could benefit from it.

If we don’t have social networks that shoulder burdens at what looks like an economic loss, there’s not enough paid care to go around at the levels of empathy we want.


The 2300 number is commonly cited, but more recent surveys suggest average panel size is much lower.

Recent studies of various practice settings in the United States and abroad found current panel sizes ranging from 1200 to 1900 patients per physician. For example, Kaiser Permanente reported a mean per-physician panel size of 1751 patients, and Group Health Cooperative of Puget Sound reported a panel size of 1490 patients per physician.18 The US Department of Veterans Affairs reported a mean panel size of 1266 patients per full-time equivalent physician.19 One study in Canada found a panel size of 1400 patients per PCP.20 A study in Denmark found a maximum level of 1600 patients per physician,21 and a study in England found 2033 patients per solo physician.22

https://www.jabfm.org/content/29/4/496.full


You make it sound like those professionals have some magical training to withstand the abuse, the stress, the bad situations of the job.

While they do have some training, it is not possible to shake some things off easily and it does get old quick. One of the reasons why drug abuse is so prevalent in some medical communities.


You seem to imply that I'm proposing something new and radical, whereas I'm actually just describing how community mental health is practised in a lot of places, including some parts of the US.

I wouldn't be willing to work as a psychiatric nurse or a social worker, but clearly plenty of people are. There are all sorts of jobs I wouldn't want that other people love and vice-versa.


I would need some firm data showing plenty of people are willing to work with people who may pose a danger to them. Retail work is considered to be bottom of the barrel because you have to deal with the general public, I don’t see people lining up to spend years of their education to deal with mentally ill customers.

At least not without significant compensation, which we as a society don’t want to pay for, considering the piss poor pay for social workers and lack of mental institutions.


A large number of people have the job title "mental health nurse" or "psychiatric nurse". A majority of those people spend a majority of their time working with the most seriously ill people. For a high-income country, the US has an unusually low number of mental health nurses relative to the overall population; there are more than five times as many mental health nurses per capita in the UK, Scandinavia, New Zealand or Japan.

https://www.who.int/mental_health/evidence/nursing_atlas_200...


It is exactly what happens in most countries here in Europe

It already exists, you don't have to invent it.


True, but this shouldn't be done on the streets. At some point they need to be "taken" to a safe facility.


People don't need to be "taken" if they actually expect the facility to be helpful. Too often there are very legitimate reasons that people expect the opposite (e.g. having experienced psych hospitals that are basically just soul-sucking money farms optimized for "processing" patients).


At some point, sure. But don't dismiss the persuasive power of free food, shelter from the elements, a bed, laundry service, etc. (especially if those are being provided by the same place! ZOMG, what a concept!) to voluntarily entice most of the homeless population to a safe facility.


What happens when this entices someone who is screaming at imaginary aliens between the hours of 3 am to 5 am, uses the hallway as a toilet, and is convinced that his neighbour wants to kill him in his sleep?

Do you force-medicate them? Restrain them? Kick them out? Or just let them ruin it for everyone else? What exactly are you proposing the institution should do?

What about someone overdosing twice a week? Do you just keep sending ambulances to drive them to the ER, until they finally die, and we can feel smug and superior that, well, at least their human rights weren't infringed?


> We closed the asylums, because the long-term detention of the mentally ill is costly and inhumane. We can do better than just warehousing people in pseudo-prisons.

How?

This is a serious question.

Right now, we are housing them in open-air prisons - the various homeless ghettos in Vancouver, San Francisco, Seattle, etc.

What exactly do you propose we do for someone who is unable to, due to mental illness:

1. Maintain their living space, or themselves in a remotely neighborly manner. (All the problems the librarian faces? Imagine living in a shelter/state housing, next door to that.)

2. Take their medicine.

3. (Bonus). Do anything, or consent to do anything about their substance abuse problem.

These are not traits that most homeless people have. Most homeless people can be immediately helped by housing first, etc, etc. But these are traits that some homeless people have. And since you're hand-wringing about institutionalization, I would like to hear what you propose, as an alternative for them.


>I would like to hear what you propose, as an alternative for them.

https://en.wikipedia.org/wiki/Assertive_community_treatment


So, "Medical professionals should spend more time helping their patients."

That's great. I fully endorse that. That's an improvement over them spending less time helping their patients.

How does this help someone who refuses to be treated? What do you do until they are willing to be treated? Keep them on the streets?


If someone is a danger to themselves or others you can detain them and force them to take medication against their will.

If they're not a danger to themselves or others you can't do either of this because they're both significant interferences with human rights. But it's important to recogise that forced hospitalisation doesn't always work, and that keeping someone banged up in hospital for two years is an expensive injustice.

So you provide assertive outreach - teams that maintain contact with people who deny their illness, and who aim to work with the patient until they're ready to engage with services.

https://www.theguardian.com/healthcare-network/views-from-th...


> If someone is a danger to themselves or others you can detain them and force them to take medication against their will.

It's possible to be someone who is not a danger to yourself, or others, and also be someone who is impossible to live next to. See: The 'harmless' guy who is screaming at invisible aliens at 3 am in the morning.

Do you let that guy into the shelter? Or do you let him carry that behavior out on the street?

What about the guy who is ODing over and over again? Can he be institutionalized? Or is he not being a danger to himself? When someone downs a bottle of sleeping pills once a week, we consider them suicidal, and we can mandate treatment - but shooting up heroin until you're passed out, barely breathing under an overpass isn't considered self-harm?


>So, "Medical professionals should spend more time helping their patients."

Assertive community treatment is about much more than conventional healthcare interventions. When delivered properly, it's an integrative and interdisciplinary approach that includes psychiatrists and psychiatric nurses, social workers, occupational therapists and peer mentors. People with severe mental illness need medical care, but they also need good housing, support in maintaining that housing, meaningful daily activity and a network of social support. Most of that support can be provided by non-medical practitioners.

If someone is offered housing and doesn't want it, they are under no obligation to take it; they have the right to make choices about their own life, even if those choices don't seem rational. A lot of people genuinely do feel safer on the streets, which is in part a sad indictment of the standard of housing on offer to the very poorest.

If someone doesn't want to work with a mental health practitioner, send a social worker. If they won't talk to a social worker, send a peer mentor. If they don't want to work with anyone, train the local police in mental health crisis management so that they can provide positive interactions.

As is so often said in addiction treatment, you can't make someone want to get better. The idea that locking people up against their will consistently facilitates effective treatment is wishful thinking at best. Some people just need time, some need the right circumstances, some need a long and patient process of rapport-building.

Some people are just very difficult to treat, but that doesn't mean we should either abandon them to fate or lock them up indefinitely to keep them out of sight and out of mind. There are a whole spectrum of useful, evidence-based interventions, many of which don't particularly resemble what we might think of as psychiatric care. With a bit of imagination and sufficient funding, we can deliver good outcomes for people who seem to have intractable problems.


> We closed the asylums, because the long-term detention of the mentally ill is costly and inhumane. We can do better than just warehousing people in pseudo-prisons.

Apparently not, because we just kicked them out onto the streets to starve and freeze to death.


>We can do better than just warehousing people in pseudo-prisons.

Interestingly, some years ago I watched a documentary (Frontline, most likely) on mentally ill people in jails/prisons. If true, it was eye opening, and changed my perception on a lot of things. They followed some of the patients around, including when they were released. The general takeaways were:

1. The mental asylums that were shut down were truly horrible places.

2. Currently the only reliable place these people get medical help for their mental issues is in prisons. And it's a much better experience than those asylums.

3. For a number of prisoners/former prisoners, life in prison was better than life outside and homeless - not because of shelter/food, but because they got treatment. Regression rates are high once they are released.

4. Providing voluntary mental health help on the outside will help some, but not many. It's just one of the problems with a number of mental illnesses that if you regress a little, you likely are not going to voluntarily seek help. The key is not to regress. When you have no family support and no help in job, housing, etc, the likelihood of regression is much higher.


Is there a state or country that you think is doing an excellent job of taking care of their mentally ill citizens?


There's no one system I'd point to as being ideal, but there are plenty of excellent examples of best practice.

The UK does many things badly wrong, but one crucially important programme is Early Intervention in Psychosis. EIP works with young people experiencing a first episode of psychotic symptoms, with the goal of preventing that episode from developing into an enduring psychotic illness. A majority of patients should be treated within two weeks of being referred. A care co-ordinator provides a single point of contact for the service user, guiding them to access clinical, behavioural and psychosocial treatment. The service provides integrated care for comorbid physical conditions and support for social issues such as social isolation, unemployment and homelessness. The available evidence suggests a 90% reduction in premature death and cost savings of £15 for every £1 spent.

https://www.england.nhs.uk/mentalhealth/wp-content/uploads/s...


But you're ignoring a simple reality: people go to libraries because there is no other place to go.

Why as a society have we decided that libraries are where hurting people are to be herded? That librarians are their outlet to be heard?

We need more and richer commons, and particularly places that encourage healthy people to stay healthy and sick people to get well.


The answer is that advocates “care” for these populations enough to ruin a public space that they don’t use in their leafy suburbs. (The suburban towns don’t put up with homeless and crazy people... they get picked up for their safety and shipped off to the city.) The rights of the crazy guy taking a dump in the middle of a library are more important than the people looking to read or learn or to have a place to be.

But that “care” for these people doesn’t extend to actually providing meaningful ways to improve their lot.


When did you decide that libraries are waystations for the wounded, as a member of society? I'm curious, because this underlies your notion.

Personally, I see it in practical terms. Regarding the policy of using a library as a resource center, giving people access to computers and training materials is a pretty darn good idea for folks who want to enrich their careers or other domains of life.


The comment you are replying to answers your question.

Q. Why as a society have we decided that libraries are where hurting people are to be herded?

A. "...we find the idea of involuntarily committing psychiatric patients to be unpalatable these days..."


That's sort of right. It's not that we find it morally unacceptable to involuntarily commit people.

It's that we don't want to pay for it. We shut down all the state mental hospitals. Which moved that population to jails, prisons, and the streets.


Taxpayers may have thought that mental asylums were expensive, but jails are very expensive. It's a lot cheaper to keep a schizophrenic in a state hospital. So I'm not sure that the decision to empty the state hospitals was driven by taxpayer stinginess.

The whole thing is complicated. Drug companies in the 60s and 70s advertised their antipsychotics very hard. They persuaded the public that drugs could cure mental illness. That was a big force behind the emptying of the hospitals.

Lots of short-sighted thinking.


The 1965 Medicaid law changes excluded any reimbursement to psychiatric hospitals with more than 16 beds.

That killed the state run hospitals. Running a 16 bed or less facility in a profitable way with Medicare reimbursement isn't possible. The money moved to other social programs.


Deinstitutionalization was not driven by taxpayers. Taxpayers have been fighting a losing war against growing social spending since 1913, and particularly since 1965. It was sociologists and other social commentators who considered it a form of oppression that drove the movement.


>Why as a society have we decided that libraries are where hurting people are to be herded?

We didn't. We instead decided that we have no right to interfere with decisions made by adults who cannot make decisions on their own.

>We need more and richer commons, and particularly places that encourage healthy people to stay healthy and sick people to get well.

Like what? What is an example of 'commons' where drug addicts or sufferers from schizophrenia can decide to go 'to get well'.


A Librarian's Guide to Homelessness

https://www.youtube.com/watch?v=FYiEEhhrFh4

Not just for librarians.

A good mix of empathy and realism, it helped me understand the social issues much better.


While obviously some are mentally unstable, and that's what drives them to the streets, what's being ignored in this conversation is that being on the streets drives many to mental instability.

Being homeless makes it difficult to find safely and sleep. Even a few days of that condition is extremely mentally taxing. Months or years? It's no surprise that so many of the homeless we see have mental issues. No surprise at all.


Lots of people who are homeless aren't living it rough on the streets, they're couch surfing or sleeping in their car. It's generally the people with some sort of mental illness who end up in the streets, because they are too unstable to be tolerated anywhere else.

I don't think there's any evidence to show that being homeless causes schizophrenia or other forms of psychosis. Depression and bitterness, sure, but likely not psychosis.


The first thing I found when looking was references to this study:

https://www.heraldsun.com.au/news/breaking-news/loose-link-f...

> Their results, released this week, reveal just over 30 per cent had a mental disorder.

> "The figure was much lower than the community perception and what other researchers had put out there," Dr Johnson told AAP.

> About 15 per cent had a mental illness before becoming homeless, while slightly more, 16 per cent, developed a disorder while on the street.

Sure, one study in one city, but assuming it's roughly correct, roughly half (if not more) of the homeless with mental illnesses developed them after living on the street.

So in addition to simply helping people not, you know, be homeless anymore, it would very likely reduce the amount of mental illnesses suffered by those who are and have been homeless.


Again, I think this author is equivocating on the word homeless. Most homeless are not the people yelling incoherent obscenities on the sidewalk.

Additionally, with something like schizophrenia, a person can have the disease and under medical care be able to function at a high level. If, for some reason, they fall out of medical care and stop taking their medication, their symptoms can rapidly spiral out of control and lead to the sort of paranoid, potentially violent, homeless person described in the librarian article. This doesn't mean their mental illness was caused by homelessness, it just means homelessness enabled it to fully manifest itself.


The study said

> About 15 per cent had a mental illness before becoming homeless, while slightly more, 16 per cent, developed a disorder while on the street.

If they were suffering from schizophrenia but it was controlled with treatment they would fall into the category of "had a mental illness before becoming homeless", not "developed a disorder while on the street".


I'd have to politely disagree. Formerly being one of these "hopeless cases", and now being a productive, healthy member of society, I feel like I have some insight into the matter.

Treatment, support and stability help immensely. We do none of that for the must vulnerable members of society. People don't end up like that overnight usually, it takes their mental health being neglected a long time. Often times the trauma starts in childhood. Can you blame them for that?

A real issue is ignorance and the resulting lack of compassion. Everyone is insecure about something, but some people make themselves feel better by judging others. The fact of the matter is we are all a few bad strokes of luck away from squabbling in the gutter. Some egos are too fragile to admit that.

Some unfortunate people may be unable to live in society, but they are in the minority and you don't know if they will respond to treatment until you try.

I am astonished that you put drug dependence in the same category as just plain violent. Mental health issues aren't a moral failing, and treating them as such further ostracizes already marginalized people.

Antisocial behavior arises when people feel rejected by society. Instead of blaming individuals from your position of privilege, perhaps you should consider the society and systems that created them.

I hope you never find out just how thin the line is.


> The kind of people who are giving the author PTSD aren't going to be helped by free housing, free money, or free anything other than free medical care, and in the extreme cases, institutionalization.

That isn't really true. Even among those with mental illness, we can divide those into two groups, those whose illness isn't treatable using current methods and those who are.

For the first case, "free healthcare" doesn't work, because they're incurable. The only real option for a violent person with an incurable mental illness is prison or something so similar to prison as makes no difference in practice.

For the second case, free money does work, because when the problem is access to healthcare, money can be used to buy healthcare. (And when the problem is something else, money can be used to buy something else.) Particularly when you combine this with some kind of system for a homeless person to be evaluated by a doctor when referred by someone like this librarian. Because once they go to the doctor and get what they need in terms of medication, once they're on the medication they would have the wherewithal to use the money to continue taking the medication (and then ideally get into a state where they no longer have to live on the street).


For the first case, free healthcare does work because they get institutionalised even if they don't have money. If you have a decent system, those places are a million times better than prisons.


We had state institutions at one point. They were basically prisons.

Moreover, any kind of forced institutionalization is always "free" -- it's not as if you can get out of it for lack of money.


Other countries, those with a somewhat decent social safety net, do not have such a big problem with homelessness. Particularly not with homeless people making public libraries unusable for the general public.


Is that really so? Homelessness rates in the US are below those in Sweden, Germany, France, Great Britain and Australia:

https://en.wikipedia.org/wiki/List_of_countries_by_homeless_...


That list is a great example on how you have to treat wikipedia with a healthy dose of scepticism. It's original research of the worst case: A list of figures from different decades(!), extracted from random news sites, without any trace of even trying to explain that there is no globally accepted definition of homelessness and that those numbers likely measure very different phenomena.

Furthermore, most of these figures includes people that are insufficiently housed like on a friends couch, in a windowless room, in temporary shelters and such, and do not tell you much about the population of people "on the streets".


Fair enough, but you literally gave zero evidence for your claim that "Other countries, those with a somewhat decent social safety net, do not have such a big problem with homelessness".

You should at least consider the possibility that what you said isn't really true and just fits your preconceived notion of a heartless US society versus a supposedly more social environment in Europe.


Heartlessness isn’t a factor here. At least individually I’d say that people over here are way more indifferent towards the homeless. There is very little enthusiasm in terms of volunteering and such.


Where is over here?

The US leads the world in volunteering. https://www.oecd.org/els/family/CO4.1-Participation-voluntar...

You can also look at BLS info: https://www.bls.gov/news.release/pdf/volun.pdf

Most cities have programs with volunteering with the homeless, just visit a nearby church and ask. Clothes, food and resumes are pretty popular things to help with.


Thats my point. There is an abundance of compassion, but a dearth of effective social security. The welfare states or Europe are a form of institutionalized compassion, but they are eroding fast.


You seem to have shifted the burden of proof to others to disprove your unsubstantiated claim, and then criticized the quality of the evidence offered.

Please raise the level of discourse here by offering new information to support your claim.


It appears to be compatible with numbers from the OECD.

http://www.oecd.org/els/family/HC3-1-Homeless-population.pdf


If you look closely, you’ll find that this data has exactly the same problems. Japan has 0.0% homelessness, because they are only counting people sleeping on the street. The millions of people living in trailer parks would likely be counted as homeless in a lot of the countries on that list. Some of these figures are official, some come from advocacy groups. It is not possible to use this data for international comparisons.


This is 100% true, but I wonder if the right level of abstraction for the 3rd largest country by population and 4th largest by area.

The USA undeniably has a low macro rates of homelessness overall, but I wonder if it has high micro levels of homelessness, e.g. Sydney seems to have lower rates of homelessness than San Francisco or Seattle, even though Australia has a higher homelessness rate than the USA overall. I wonder as I can't find any data that uses the same measurements across cities and countries and is easy to compare.

On numbers, Seattle has 12,000 homeless according to wikipedia, and I can't find similar numbers for Sydney. Given Sydney is about 15% larger than greater Seattle, it would need to be closer to 14,000 to be the same. I doubt Sydney has that many Homeless, but with no data I guess it may.

I could be completely off base here, but I do think the USA has some really concentrated pockets of homelessness, and that skews people's views, in both directions, based on personal experience.


The question is, does homelessness become more of a problem if it is "more concentrated"? I would argue that for the homeless individual, it actually doesn't. It's in fact probably better to be homeless in a place that is already accustomed to homeless people.

Of course for the perception of a non-homeless person, the problem will appear more drastic with a higher concentration.


>and in the extreme cases, institutionalization.

Worse than that, the family and loved ones of the homeless individual have almost no rights to institutionalize them to get them the care they need. It is unbelievable that we're OK with it.


I've had this conversation with people in other countries when they ask why there are so many homeless in America. I ask them what their country does with mentally unstable homeless? They're response is they are not allowed to live on the street and they are "picked up".

We can decide to let people have complete autonomy or they can be "picked up".


Mhh, in my country they're only picked up when its too cold to stay outside. Other than that we have many shelters where people can stay overnight for a euro or so.


As there are in LA and NYC. Many people don't want to go for whatever reason so they stay on the street.


Picked up means that they are taken freely to an hospital, they give them a bed, food, they check their conditions and can sleep there a night or two. At least in Italy, where my parents worked in hospitals and took care of many homeless or just troubled people.

It's not like the Nazis taking prisoners to the camps...


A lot of these people, I would wager the majority , had bad childhoods. Resulting from vicious cycles caused (in part) by poverty. I would also wager in a fairer parallel universe where this wasn't the case, a good number of these people wouldn't have grown up to be as mentally ill as they are.


Schizophrenia -- responsible for much of the extreme behavior that librarians see -- is an organic disease that affects both the rich and poor at equal rates. It has nothing to do with how you were raised.

It's true that wealthy families can afford much better care for their schizophrenic family members, but poverty certainly does not cause schizophrenia.

Otherwise, I strongly agree with you that generational poverty is a critical societal problem to be solved.


>Schizophrenia -- responsible for much of the extreme behavior that librarians see -- is an organic disease that affects both the rich and poor at equal rates.

A laundry-list of adverse life experiences associated with poverty are known to increase the risk of schizophrenia.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181718/


That's mostly a laundry list of hypotheticals, aside from the seasonal study which had some statistically significant data indicating correlation. All the childhood environmental factors that might have some small relation to poverty were described in that section as "proposed" or "discussed".

It's entirely possible that some environmental factor associated with poverty might exacerbate the genetic factors responsible for the disease, but all things considered, schizophrenia is known to be a disease that affects rich and poor alike, across the globe, across cultures.


correlation or causation?


Of course that study can’t prove causation (not going to do a randomized trial on risk factors that cause schizophrenia), but they only looked at risk factors prior to onset, so that should be a good proxy.


I suspect free housing and other social safety nets would prevent people from deteriorating to this state, or at least mitigate the effects.

I imagine other developed countries don't have this problem to this extent. What do Denmark or Japan do that we can learn from?


The US does pretty well in terms of homelessness rates (see link above—half the rate of Sweden). Japan’s is a lot lower, but Japan relies primarily on private charity to deal with homelessness. (Mental health issues are much more stigmatized than they are in the US. It’s relatively recently that Japan even started seriously studying the problems of homelessness at the government level.)


The US apparently has a much higher rate of unsheltered homeless people though. This is a quora answer, but there are sources at the bottom: https://www.quora.com/Is-homelessness-as-bad-in-Scandinavia-...


The problem is that you don't offer any solution. Sure, some homeless people, schizophrenics, and sociopaths are unpleasant to deal with and will find themselves unwanted wherever they go, both due to their own actions and due to prejudices and fear.

They go to libraries, house entrances, metro stations, and so on because they have no other places to go. Putting them out of your sight will not make the problem go away.

The solutions are obvious and not mysterious at all. What do most of them need? Good social programs, free health care, job programs that work and are not just designed to "improve" statistics, personal mentoring, places to go where their few belongings are safe and they are not surrounded by criminals and troublemakers all the time, proper psychiatric care, drug help centres with medical professionals who are not allowed to cooperate with the police except in case of capital crimes, and so on and so on. What do they not need? Well, there are always hard cases and dangerous criminals can be mentally ill like anybody else, but generally speaking, as a rule of thumb, the last place you'd want to put them are US prisons, because the people who leave them are more likely to be mentally ill than the people who enter them.

The quality of a society can be measured directly by how they deal with their outcasts and troublemakers.


> The solutions are obvious and not mysterious at all. Good social programs, free health care, job programs that work and are not just designed to "improve" statistics, personal mentoring, places to go where their few belongings are safe and they are not surrounded by criminals and troublemakers all the time, proper psychiatric care, drug help centres with medical professionals...

All these things exist in many developed countries, but they don't solve the problem either. Schizophrenic people in particular are unlikely to actually accept help. They're incapable of appropriately judging the reality around them. They can't tell if somebody is genuinely trying to help or if they're "out to get them".

So you would have to force them into psychiatric care, but that's often not legally possible, and for good historic reasons.


>and for good historic reasons.

Is it? I'm not convinced that we haven't over-inflated the harm of psychiatric institutions from 50s and 60s and 70s. I wonder if the spate of horror movies set in mental institutions are partly to blame in addition to over-focus on practices that have long been banned.


> All these things exist in many developed countries, but they don't solve the problem either.

You're just claiming this without providing any evidence and I believe this to be false (in tendency), unless by "solving the problem" you mean "perfectly solving all problem in each and every case". In general, adequate medical treatment and improved living conditions will improve the situation. With proper medication and treatment people can live with schizophrenia.

As for putting people who pose no threat to the public or to themselves into closed institutions against their will, this is obviously immoral and not even worth discussing. At the meantime, every country I know of already as laws for mandatory closed therapy of people who actually pose threats. That includes the US.

Overall, it's not clear to me what you were trying to say. Given that the obviously immoral solution is out of question, that there always remain some problem with the outliers for which the help doesn't work? Of course, these will always exist, just like there always will be criminals. But that's a truism.


> With proper medication and treatment people can live with schizophrenia.

Am I supposed to just repeat myself? Schizophrenics refuse treatment a lot of the time. They can't tell you want to help them when they have paranoid delusions. Then what do you do? Unless they're provably a threat, you have to let them go their way, unmedicated.

> Overall, it's not clear to me what you were trying to say. Given that the obviously immoral solution is out of question, that there always remain some problem with the outliers for which the help doesn't work?

Your "obvious solutions" are not solutions. You make it sound like a solvable problem. It's not. It's really a tradeoff between public safety and personal freedoms.

Mental illness is not an "outlier". About 30% of the homeless suffer from severe mental illness:

https://web.archive.org/web/20121231000856/http://www.calpsy...


30% is fairly low, and your suggestion that schizophrenics refuse treatment a lot is pointless. Some of them refuse it, other do not refuse it, and you help those who do not refuse it.

The situation of homeless is not as bad in countries with better systems as it is in the US, precisely because, as a tendency, their situation can be improved and less is done in the US than in other countries. The effectiveness of social welfare programs, health care, and so on, is a purely empirical question that can be measured effectively. Contrary to popular belief, these are not questions of political opinion. (What is a matter of political opinion, of course, is how much you want to spent and who is going to pay for it.)

You could e.g. start by helping the 70% of those homeless who, according to your own statistics, do not suffer from severe mental illness. That's already the vast majority.

As for the remaining 30%, the suggestion you're trying to make, that they are all hopeless cases, is outright bizarre. We know that schizophrenia can be treated with medicaments and that not all of the people diagnosed with schizophrenia refuse treatment. You could start by treating those who want to be treated, for example.

Finally, you still haven't bother to tell anyone what to do about the 30% you incorrectly portray as being untreatable, because they allegedly refuse treatment.

If your suggestion is to put them into mental institutions against their will, even when they pose no threat to the public or themselves, then my reply is that you need to check your moral compass. This is prohibited by law and by very basic moral considerations. If you have another suggestion, rather than stating the obvious truism that not every schizophrenic can fully adapt to society or be treated effectively, then I'm all ears, and so are myriads of medical professionals and street workers.

Right now, to me you merely come across as someone who doesn't really have anything to say about the topic. As I've said, it works better in many other countries, so your idea of not helping at all does not really seem to be very convincing to me.


> 30% is fairly low, and your suggestion that schizophrenics refuse treatment a lot is pointless. Some of them refuse it, other do not refuse it, and you help those who do not refuse it.

Those who don't refuse treatment tend to not be homeless. Maybe you should have a conversation with a social worker or a medical professional about homelessness if you still believe homelessness has an "obvious solution".

> You could e.g. start by helping the 70% of those homeless who, according to your own statistics, do not suffer from severe mental illness. That's already the vast majority.

Yes, we can have another conversation about how helping drug addicts is really difficult. We can talk about how hard alcoholics can't hold jobs or maintain a household. We can talk about all kinds of issues that are not solved by simple having more social programs than we already have.

> Right now, to me you merely come across as someone who doesn't really have anything to say about the topic.

You come across to me as someone who doesn't really have a good understanding of the actual problem. All you have to say is "the solution is obvious, more welfare programs! Throw money at the problem, it'll disappear!". It's just not true. No country in the world has "solved" homelessness while maintaining the level of personal freedom that you yourself seem to be vigilant of.

My point is not that we should institutionalize all these people, or that there shouldn't be more programs available. In fact I would argue that drugs in particular need to liberalized to keep addicts in the programs.


> Those who don't refuse treatment tend to not be homeless.

You just literally said that 30% of the homeless are severely mentally ill. That means that 70% of the homeless are not severely mentally ill.

And you have not proposed any solution or way to tackle the problem at all. Not a single suggestion.


> You just literally said that 30% of the homeless are severely mentally ill. That means that 70% of the homeless are not severely mentally ill.

In context of the reply, the sentence is: Those schizophrenics (not "those homeless") who do not refuse treatment tend to not be homeless.

> And you have not proposed any solution or way to tackle the problem at all. Not a single suggestion.

I don't have a solution and neither does the parent. Why should I make poorly informed suggestions on what should be done? To appear virtuous? Well here you go:

Every homeless person should get a Macbook and free Javascript courses so they can get a job in San Francisco!

Is that what you expect out of people?


The parent has suggested a number of solutions, and you have not presented a convincing argument why any of those solutions would not help. You started by insinuating that most homeless are incurably schizophrenic. Then you looked it up on the Internet and found out some (fishy) statistics that stated that only 20% - 40% of all homeless are seriously mentally ill, so you backtracked and replaced your original suggestion with the statistically incorrect claim that 30% of all homeless all incurably schizophrenic and refuse treatment without presenting any evidence for that claim either. (Hint: This doesn't follow from the revised statement you gave in your last reply, for which you have also presented no evidence btw.) And when pressed about what it is you want to say, your overall point was that nothing can be done to help those schizophrenics among the homeless who refuse help. But the other poster already conceded that there is always a certain percentage who cannot be helped, so the two of you don't even disagree.

The only point that you backed up with some citation was the claim that only 20% to 40% of all homeless are seriously mentally ill, which seems to support the idea that it may be possible to start helping the majority 60% - 80% of homeless who are not seriously mentally ill. And, to make this clear, the vague suggestion that most or many homeless people who suffer from schizophrenia often refuse help wasn't really informative or helpful. Not without actual numbers and actual evaluation of help programs.

Your repeated suggestion that there is no solution and nothing can be done has certainly not convinced me.


> The parent has suggested a number of solutions, and you have not presented a convincing argument why any of those solutions would not help.

There's a difference between "a solution" and "mitigation". All those programs that the parent mentioned do exist in so-called "welfare states" like Sweden, France or Germany. Yet, these countries have higher homelessness rates than the US.

> You started by insinuating that most homeless are incurably schizophrenic.

I actually didn't. I said that schizophrenics in particular are likely to refuse help. I didn't say all schizophrenics refuse help or that all homeless are schizophrenic.

If you can't solve the problem of getting those schizophrenics off the streets (without force), you can't have a solution to homelessness, period.

> Your repeated suggestion that there is no solution and nothing can be done has certainly not convinced me.

I didn't say nothing can be done. I particularly don't care about "convincing" some guy on HN with poor reading comprehension. Have you done anything besides complaining about my posts? Go educate yourself on the topic if you want to "prove me wrong" or something.


> I didn't say nothing can be done. I particularly don't care about "convincing" some guy on HN with poor reading comprehension.

You're the last person on HN who should tell other people about reading comprehension, at least judging from this thread.

> > You started by insinuating that most homeless are incurably schizophrenic.

> I didn't say all schizophrenics refuse help or that all homeless are schizophrenic.

That's a typical example of your reading comprehension, which is based on constantly shifting the goalpost in order to "save face." And that is the reason why you're so unconvincing. You did start by insinuating that most homeless are schizophrenic and that most schizophrenic refuse to get help. Both statements turned out to be plain false according to your own Internet research - which you obviously conducted because you're not very familiar with the topic, otherwise you would have mentioned your single data point, namely the paper you linked to, right from the start. You dynamically adapted your claims instead of doing the mature thing of simply admitting that you were wrong and less homeless people than you thought were mentally ill.

> There's a difference between "a solution" and "mitigation".

This kind of hairsplitting is an immature reaction when someone points out inconsistencies in a post.

The fact is that in the end you said almost nothing, but you managed to achieve that goal with erroneous reporting of statistics, peppered with several false dichotomies and a lot of insinuation. So some percentage of the (i) 20%-40% of homeless that are seriously mentally ill might (ii) be schizophrenic, and of those (iii) some other percentage might refuse treatment, and for (iv) those there may be no solution. Nobody has ever denied that in this thread, and what is even more stunning about this conversation is that you have provided 0 evidence for claims (ii)-(iv). Zero. No data, no statistics, not even an argument that would withold basic scrutiny. That's not a good track record, especially not for HN.

Now you're again shifting goalposts and there is a new insinuation, of course. Now suddenly you're coming up with general homelessness rates. I suppose the insinuation this time is that mitigation strategies of welfare states like Sweden, France, and Germany don't help against homelessness - which is, of course, another obvious nonsense that could not possibly be backed up by looking at homelessness rates alone. Again, you're using the wrong data to insinuate something while keeping the actual position as vague as possible. You could just as well have mentioned North Korea and Jordan as positive examples with alleged 0% homelessness. Or that Mexico has a much lower homelessness rate than the US. Or that a welfare state like Portugal has a much lower homelessness rate than the US, too. And so forth. Fact is, of course, that homelessness rates cannot be compared in this way and that public policies need to be evaluated much more carefully by looking at their concrete effects.

> Go educate yourself on the topic if you want to "prove me wrong" or something.

That's called "projection" in psychology.


> And that is the reason why you're so unconvincing. You did start by insinuating that most homeless are schizophrenic and that most schizophrenic refuse to get help.

I made a plain statement. I don't have the need for "insinuations". If I had wanted to say anything about "most homeless", I would've used the word "most", as I have in all other instances where I used the word "most".

By using the word "insinuate" you are yourself weaseling out of having misread what I said. You can't just say I said something that I didn't say. So I must've "insinuated" it and you get to decide what I insinuated, not me. That's just really poor debating tactics.

> Both statements turned out to be plain false...

I never made such statements. Goalpost moved.

> ... which you obviously conducted because you're not very familiar with the topic, otherwise you would have mentioned your single data point, namely the paper you linked to, right from the start.

You are correct in guessing that I looked the number up after writing the comment.

> You dynamically adapted your claims instead of doing the mature thing of simply admitting that you were wrong and less homeless people than you thought were mentally ill.

You're basically engaging in mind reading now. My claims didn't need adaption because I never said anything premised on the proportion of schizophrenics among the homeless. Whether 30% is "more or less" than what "I thought" is irrelevant. I didn't have a number in mind at all.

> This kind of hairsplitting is an immature reaction when someone points out inconsistencies in a post.

Another poor debating tactic - accusing the other side of "arguing semantics".

> ...several false dichotomies...

Really? Cite two.

> That's not a good track record, especially not for HN.

Dude, you're not exactly helping out with these kinds of posts...


> About 30% of the homeless suffer from severe mental illness

80.2 million Americans (25% of the 325 million total population) suffer from mental illness so severe they take drugs to treat their condition:

https://www.cchrint.org/psychiatric-drugs/people-taking-psyc...

This does not include the number of people who suffer from mental illness that does not require drugs for treatment or those who would benefit from drugs but who do not wish to or can not afford to take them, or who are undiagnosed. So the actual number with severe mental illness is much higher than 25% of the population.

Above, DanHulton tracked down a study that also found that 30% of homeless suffer from mental illness:

https://news.ycombinator.com/item?id=19707763

https://www.heraldsun.com.au/news/breaking-news/loose-link-f...

> Their results, released this week, reveal just over 30 per cent had a mental disorder.

> "The figure was much lower than the community perception and what other researchers had put out there," Dr Johnson told AAP.

> About 15 per cent had a mental illness before becoming homeless, while slightly more, 16 per cent, developed a disorder while on the street.

Since only 15 percent were ill before becoming homeless, this means that homeless people are much less mentally ill than the general public.

It is a disproven myth that homeless people are more likely to be mentally ill than the general public. It is also a dangerous myth since belief in this myth drives nearly all discussion and proposed solutions (such as institutionalization, imprisonment and forced drugging) to address the problems of widespread poverty, lack of universal basic medical care, lack of affordable decent shelter, etc, in the US and in several other industrialized modern countries.


> 80.2 million Americans (25% of the 325 million total population) suffer from mental illness so severe they take drugs to treat their condition

That's not the same as having "severe mental illness". Doctors in the US hand out psychomeds like candy to anyone who has a mild depression. That's how you get to 25%.

> It is a disproven myth that homeless people are more likely to be mentally ill than the general public.

It isn't. You just took some numbers from one bucket, put them next to numbers from another bucket and then concluded that for some unexplained reason, it's actually the people who become homeless that have on average better mental health than the general population. Non-Sequitur.

Mind you, I never said that the majority of homeless people are mentally ill, but there's a set of hard cases that you will literally not be able to help with any program that is meant to get them off the streets.


>As for putting people who pose no threat to the public or to themselves into closed institutions against their will, this is obviously immoral and not even worth discussing.

Why is it obviously immoral? Is it moral to allow people who cannot make decisions for themselves to live in squalor and filth?

Looking at it another way, municipal governments set living standards for housing, with requirements around sanitation, access to clean running water, heating, etc. ... unless you're a drug addict or a sufferer of mental illness, in which case go right ahead and live in a tent city surrounded by filth and vulnerable to the elements, disease and crime?? That's your moral option? Ask politely the individual if they would not like to live in squalor and if they say 'no', leave them be?


> Why is it obviously immoral?

Why is it immoral to lock away people against their will, people who have not committed a crime? Because freedom is a basic human right.

The moral option is good street work, effective welfare programs and to give people housings rather than let them live in tent cities in filth and disease, something against which to which other poster has vigorously objected without providing any argument for his position other than falsely claiming that these people are all incurable schizophrenics.

What's wrong with people in the US that this even has to be discussed?


>Why is it immoral to lock away people against their will, people who have not committed a crime?

That's unfair. It isn't right to talk about doing things against the will of an individual who isn't a free actor due to their condition. This is very well established notion legally, culturally and morally. For example, if a schizophrenic person commits murder, their condition is a mitigating factor in their sentencing and will prevent them from simply being locked up with the general population.

Similarly, you're already treating them as individuals incapable living up to the responsibilities of living in society. All municipalities have zoning laws to control where citizens can live and laws against squatting in tent-cities or on a sidewalk and living in squalor and filth, without proper sanitation, and protection from elements - yet somehow you still argue that those laws should not apply those individuals. So you're trying to have your cake and eat it to. On one hand, you're saying forced institutionalization where care could be provided, is wrong because those individuals CHOOSE not to be institutionalized, and on the other hand, you're arguing they shouldn't be held to the same responsibilities as other citizens because they can't help their situation.

This position is arbitrary and incoherent.

Finally. I disagree with your contention that institutionalizing people for the purpose of providing care (not locking them up - as you called it) who aren't capable of making their own decisions is immoral - and you haven't attempted to show why it is, you just assert it as a fact - which it isn't.

>What's wrong with people in the US that this even has to be discussed

I'm not American.


Your arguments are based on various false dichotomies and false analogies.

I have given a reason why incarcerating adults who have not committed a crime against their will is obviously immoral, namely because freedom is one of the most fundamental human rights. Of course, there can be reasons that might outweigh this right, for example when someone has committed a serious crime and there was a fair trial. Another reason would be the medical assessment that the person would likely severely harm himself or others. For the latter, the hurdles are extremely high. You can ask your lawmakers why they think they should be high. They will probably tell you that's because freedom is one of the most fundamental human rights.

"Caring" for someone is traditionally not considered a sufficient reason. And that includes parents, who are definitely not allowed to lock away their children indefinitely (as a reply to the other poster, who seems to be even more confused than you).

> you're arguing they shouldn't be held to the same responsibilities as other citizens because they can't help their situation.

I have never argued for such an absurd claim at all, in any form whatsoever.


>I have given a reason why incarcerating adults...

You haven't actually answered the one objection I have, namely, why do you think it moral to let distressed individuals who cannot make decisions for themselves live in filth and squalor. Apparently, this is a human right - which is insane.

But let's leave it at that. I'll simply state that I disagree with your position. Moreso than that, I find that position highly immoral.

>I have never argued for such an absurd claim at all, in any form whatsoever.

I didn't say you argued it, I asked what your position is on that. It is actually illegal to pitch a tent on a sidewalk and live there. It is illegal to setup a 'tent city' for purpose of long-term habitation. There are plethora of laws preventing that kind of behaviour. And I get it, you don't admit to the moral imperative of institutionalizing those individuals to provide care, but then are you OK with enforcing laws on the books against those individuals - because that isn't done either if you go to cities like San Fran and LA and enforcing those laws would lead to heavy fines or incarceration, if you treat those individuals as rational actors expected to live up to the responsibilities of living in a society.


Plenty of individuals who can make decisions for themselves live in filth and squalor, too. As long as they don't cause serious harm or violate other basic moral standards like the freedom of others, right to property, etc., people's life choices are not and should not be controlled by the state.

> Apparently, this is a human right - which is insane.

It is one of the most fundamental human rights and not insane at all. Some scholars would even argue that autonomy is a defining characteristics of being a moral agent.

Every human has a right to make mistakes, too.

Generally, freedom can only be restricted when serious harm would be caused otherwise. There used to be a consensus about this in every capitalist democratic society, and I still think there is one. That's why your reply is kind of surprising to me.

> are you OK with enforcing laws on the books against those individuals

The laws are the same for everyone, whether they are homeless or not does not play any role. otherwise the law is unconstitutional. At least that's how it works where I live.

To answer your question: Of course, I'm not fine with any kind of laws that would be specifically bad for homeless. Imposing fines on people who cannot pay them is pointless and there is something wrong with a law that does it. Replacing fines by incarceration when a person could not possibly pay the fine is equally stupid, and btw in many countries this is not how it's done. Where I live you can declare personal bankrupcy in a similar way as companies can do it. You will still have to pay off your debts once you have a job, though.

If your laws would put homeless in more misery than putting them into mental institutions against their will, then there is something wrong with those laws. Besides, people don't set up tent cities because they prefer to live in tents. This is simply false and where I live such tent cities don't exist. Ghettos and tent cities hint at deeper problems in your country, problems that will likely not be solvable by reforming laws alone.


I hope for the sake of the homeless, people like you are not involved in defining any future policy.

On the other hand, you can take solace in the fact that your perspective is the one that governs homeless policy today ... and you can see the end result.


Well, one thing is sure, that you should never be put in charge of designing future policies for how to deal with homeless people, given the atrocities you're suggesting.


> I disagree with your contention that institutionalizing people for the purpose of providing care (not locking them up)

Speaking about England: most of the people I talk to who've been detained under section of the mental health act (involuntarily committed to hospital) talk about it as being locked up, even if they're on an unlocked ward.

There are strict legal protections in place to prevent abuse of powers, although these aren't always being followed.

There has recently been a review of the English law to see if too many people are being detained.

You should view this as more severe than a prison sentence, because that mindset allows you to put in place the protections of freedoms needed to guard against abuse.


How about keeping 4-15 year olds locked away against their will, when they'd much rather run out into the street than be in the kindergarten or school? Or e.g. dragging them away from the candy aisle by force, or forcing them to go to bed when they'd rather watch TV at night? How about keeping 15-year-olds locked out of pubs and arbitrarily forbidding them to operate a vehicle (severely restricting their freedom of movement in much of the US) against their will?

You can discuss the finer points of various restrictions, but there's nothing morally wrong with restricting someone with reduced mental capacity, below some basic level of competence, according to their mental capacity.


> but there's nothing morally wrong with restricting someone with reduced mental capacity, below some basic level of competence, according to their mental capacity.

You state this like it's obvious, but it really isn't that obvious and there are severe problems with detention of people who don't pose a risk of hamr to themselves or others. And there's even problems if they only pose a risk of harm to themselves. The UK sees people banged up for years becuase they pose a risk of harm to themselves, when what they really need is better community treatment.


I'm pretty sure I would have been fine driving a car as soon as I could reach the pedals, and school was a waste of time after 5th grade; why did they restrict my freedom when in the latter case I'd at most harm myself? There were obvious and severe problems with that. Somehow we decided that after a certain age you can do whatever you want (more or less) and the constraints that arise from the fact that you are incapable, and dependent on care, stop applying. THAT is a completely arbitrary standard.

The only argument I can think in favor of this is that arbitrary age-based standard is much harder to abuse. But that is a (valid) implementation problem, not a moral one.


>You state this like it's obvious,

But it is. We do that all the time like, for example, during criminal proceedings. We understand that an individual with particular mental handicaps may not be fully (or at all) capable of making rational decisions and therefore should not bear the full responsibility for their actions.

>when what they really need is better community treatment.

What do you think 'community treatment' means!?!?!? You let them live in a filthy tent, with no clean water, no sanitation, no protection from the elements, with an occasional visit from a social worker to make sure they don't have cholera and have a blanket so they don't die from exposure?? That's your definition of 'community treatment'???


That's a false analogy. You have to bear in mind that the diagnosis of mental diseases has a fairly high failure rate and many behaviour that used to be classified as a mental disease has turned out to be perfectly fine.


That's your argument? That modern psychology and psychiatry is incapable of diagnosing debilitating conditions like schizophrenia in an individual living in a filthy tent-city - therefore we should err on the side of caution to such an extent that we cannot make a judgement call on anybody?


Of course we should err on the side of caution when deciding whether to lock someone against his will for an indefinite time into a psychiatric facility. What else did you think? Do you have any idea about the guidelines for psychiatric evaluation of such cases and their judicial oversight? Why the hurdles are set high? I don't believe you have, to be honest.

Maybe you start by thinking about how you would like to be treated if you happen to start suffering from schizophrenia, and then read up a bit on freedom and other fundamental human rights. Then you could read up on actual laws and the guidelines for psychiatric evaluations. Then at least you would have something to say.

> therefore we should err on the side of caution to such an extent that we cannot make a judgement call on anybody?

Well, I haven't said that, you're replying to a strawman. There is also no need to use an ominous "we". There are psychiatrists who make the judgement call under judicial oversight and their main criterion is, of course, whether the patient poses any imminent danger to himself or others. This is regulated by existing laws and procedures. Anything beyond that is illegal and, as I have argued, also immoral.

Overall, I have to say that some of the replies I've seen in this thread are far below the usual level of HN. It seems that some people have a personal vendetta against homeless people, or otherwise I can't explain that behaviour. At least, I seriously doubt that the same people would be willing to suggest that their mother or their wife should get locked up in a mental ward against their will if they happen to get ill from schizophrenia but nevertheless do not pose any danger to themselves or others - which was the premise of that discussion, mind you.


>Why the hurdles are set high? I don't believe you have, to be honest.

And I agree with that. Those standards should be high. The problem is that they seem to be so high as to make it impossible when looking at actual policies of West-coast municipalities.

>Well, I haven't said that, you're replying to a strawman.

I am really trying to understand what the standard is that you're advocating for because thus far it seems like it should never be the case that a homeless person with a mental illness is institutionalized.

>It seems that some people have a personal vendetta against homeless people, or otherwise I can't explain that behaviour.

That is an unfair assessment and you know it. The fundamental disagreement is that because we're talking about people who cannot make decisions because of debilitating mental illness some of us argue that therefore we should make certain decisions for them - one of which is, to provide them with care in a better setting than a tent-city. We're not talking about incarcerating or institutionalizing a 20-something that decides to live in a van.

Have you actually done any work with homeless? The face of homelessness is the face of drug addiction and/or debilitating mental illness. I suspect that there are people who still view homelessness in light of great depression where the homeless where those of sound mind simply seeking work, or run into some bad luck, and not have enough money to pay for housing. This is not the reality of homelessness in our society.

>At least, I seriously doubt that the same people would be willing to suggest that their mother or their wife should get locked up in a mental ward against their will if they happen to get ill from schizophrenia

Are you serious? It isn't even close. I would absolutely want my loved one to get the care they need instead of languishing in the streets. This isn't a choice between an individual living in a nice apartment with family and friends being around the corner to take care of their needs, and a government mental institution. This is a choice between being in a filthy, dangerous tent-city exposed to the elements or a government mental institution. It is a no-brainer. How could you think otherwise???!?!?

Maybe it is the specific handicap that you're objecting to. Maybe you think you can be a functional schizophrenic to the extent that you can choose to live in a tent-city in filth and therefore that right should be respected.

But what about others? What about someone suffering from Alzheimer's or dementia - when those people wind up homeless, is it OK to institutionalize them??? Or still not?

I'm really struggling to understand your standard here, because it's easy to say that every individual has a fundamental right not to be 'locked up' (as you put it), but then I don't know how you square that with realities on the ground that these people end up in atrocious circumstances.


Is it a more reliable predictor of mental incapacity than an arbitrary number of revolutions of a planet against a star, the one we use for driving, voting, drinking, and even straight up confinement as with schools?


I don't buy the "incompatible with society" argument. It just sounds like an excuse not to help them. If you were in their shoes you would probably go crazy too.

Just yestersay some spanish tourists were asking me why were there so many homeless people in SF. I told them "America".


> I told them "America".

How w is this an A answer? It doesn't tell you anything about _Why_ there are so many homeless people.


American people will in general not fight for the man. They will fight against wellfare, healthcare, aids, etc


The problem with how we treat the poorest people in the country is that we have a fair number of completely psychotic people who spoil the whole social support network for everyone else by requiring 100x the help everyone else does because they are actively destroying the facilities and people that try to help them.

In Western Europe these people are likely held against their will in mental institutions, but in America, especially in San Francisco we'd rather they be out walking around off their meds if they haven't murdered anyone yet. There are homeless people who regularly randomly assault people for no reason and as long as they don't use a weapon they are back out on the street in 24 hours.


> especially in San Francisco we'd rather they be out walking around

It's not a question of preference. Our constitution is incompatible with treatment programs that involve indefinite imprisonment when the individual is not a serious threat to himself or others.

1. https://en.wikipedia.org/wiki/O%27Connor_v._Donaldson

2. https://en.wikipedia.org/wiki/Addington_v._Texas


Not arguing, but I find it somewhat strange that living - often in atrocious squalor - on the streets isn't seen as causing serious harm to oneself? It certainly isn't harmless, not even close.

Further, If your actions as a semi-coherent group are enough to cause PTSD in library personnel, how can that not be considered as being dangerous to others? PTSD is no joke, it can easily lead to life long suffering.

With that said. Assuming the constitution really disallows all forms of "closed" psychiatric care and it's not only a convenient interpretation.Then the lack of, or reduction in other kinds of care still points to the actual reasons for effective care being something different than simply an issue of law. It might in addition be a matter of law, but certainly not only a matter of law. If it were then somehow a way to work with/around that would have been found, as always happens. The will of a significant majority has never been stopped by what's written in in any law ever.

There is a fair number of homeless that would voluntarily get treatment/help/support if it was readily available, of high quality, and safe.

But. Care for homeless is almost universally terribly underfunded, and this is clearly a willful act of society.


> It certainly isn't harmless, not even close.

True, but it's usually not an immediate threat, and that's the one where people get hospitalized. Living on the streets certainly isn't good for your health, but it's closer to "smoking, drinking and unhealthy diet" than to "putting a razor to your throat" in terms of immediacy, and it's the latter part where most people agree that the state can and should act against your "will".


The article mentions a scenario in which someone was "throwing books, newspapers and plastic sign holders at us, screaming that he would kill every one of us." This is not about living unhealthily.


And an example like that isn't what "the homeless population" in general does on a daily basis. That's where the state can interfere, but it's the large majority that doesn't snap that live unhealthily but aren't an acute danger to themselves or others.


My wife works in an urban library. Every day she describes a similar incident. They have multiple guards. At a library...


Yeah, and that's terrible, I'm not saying that it's not happening or that it's not bad. It's just that there are many homeless people that don't act that way, so you can't solve homelessness by institutionalizing people against their will. The vast majority aren't an immediate threat to themselves or others. Some are, and most people are okay with forcing help on them. For the rest, offering help is all you can do, but if they aren't ready to take it, you can't force them.


I'm not sure if laws in Western Europe are fundamentally different. In the Netherlands the law[1][2] states you can only be involuntarily committed if you're a danger for themselves or others and if this is the only remaining solution. It seems roughly analogous to those two SCOTUS cases, although details and/or practical implementations may differ.

[1]: https://www.ggznederland.nl/themas/gedwongen-civiel

[2]: https://www.dwangindezorg.nl/rechten/wetten/wet-bopz


It’s the same in Sweden, I think most of Europe is like this since at least 30 years.


Any other refs on how the Netherlands deals with homeless? I am shocked by how few homeless there are.


I'm currently traveling around Europe. In Spain, Germany and Austria I'm seeing a lot more homeless and beggars since the migrant crisis of the last few years. Germany allowed 1 million to settle so it's not a surprise really. They do seem to prefer to be homeless in Europe rather than be in their home countries from the couple that I've spoken to.


I think it's far more involved than just "dealing with the homeless". After I moved to the UK a few years ago (from NL) was shocked by the amount of homeless people.

After renting for two years I was evicted with a 2-month notice for what was essentially a simple disagreement with the landlord. They didn't even attempt to resolve it: they just evicted me.

It took me over half a year to get half of my £1 100 deposit back; they initially tried to charge me £1 400, mostly for bullshit general maintenance and/or lying about either the initial state – even though it was unambiguously stated in the original inventory – or agreements we had made about the checkout condition (I asked if I had to fix a few minor issues, they said no, and then charged me anyway). About £100 was reasonable, the rest wasn't.

My point here is, all of this would be highly illegal in the Netherlands. You can't just evict people because you feel like it, and you can't just send a bill well over a month later for all sorts of items (or maybe you can, but it's certainly not common[1]). It's not hard to imagine how I could have ended up homeless if I had been more vulnerable – for example by actually needing that £1 100 deposit for a new deposit, or suffering from depression or other mental illness, etc.

I think homelessness is a complex problem, and dealing with people after they become homeless is a only a part of it. This is not very scientific, but in general, I've observed that homelessness is correlated with the amount of empathy in a society, which is something that affects many laws and attitudes.

[1]: A little footnote: technically also not legal in the UK, but they interpret "notify about deductions within 10 days" as "send standard form letter that there may be some deductions within 10 days", which is obviously not the same. But ... what can you do about stuff like this as a tenant, right? I might have considered the small claims court, but have since left the UK as I was fed up. Even "notify within 10 days" is already very strange, as this means they have all the time to collect all the evidence, while robbing me the chance of actually giving any sort of counter-argument. In NL, it's always been arranged at the checkout, with both parties present.


> After renting for two years I was evicted with a 2-month notice for what was essentially a simple disagreement with the landlord. They didn't even attempt to resolve it: they just evicted me.

Were you actually evicted, or did your lease simply expire without an option to renew? Because even here in the US, it's very hard to impossible to evict someone who has a lease and is still paying rent and isn't flagrantly violating laws or destroying the dwelling.


I'm not sure if "evict" is the correct legal terminology; probably isn't. But it is what it effectively amounts to, so it's what I'll call it.

Details: https://www.gov.uk/tenancy-agreements-a-guide-for-landlords/... – tl;dr is that after 6 months you can just end the tenancy agreement with a 2 month notice.

Assured shorthold tenancies are pretty much the standard; you don't have a lot of choice. Either sign a contract like this, or don't have a house to live in :-/

The entire thing is seriously fucked up if you ask me, because at the slightest hint of being "difficult" (e.g. because you demand they actually fix things, or because you object when they act like assholes) you just get evicted :-/


I haven't rented in ages, but every time I have, we had a walk-through with the landlord upon leaving the property. As you say, that's the only way to ensure both parties have a fair chance at keeping/regaining whatever part of the deposit they are due.

That said, I also never rented in a major city. Mostly during college in a small city, and while most students were a bit clueless, their mostly middle-class parents were not. Then a few homes after college, but again, in a wealthy suburb where tenants typically had the means to enforce their rights via the courts.


The landlord wrote down some stuff. I asked afterwards, he mentioned one thing, we discussed another thing and he seemed to agree with me, and that was it. Talking to some other people in the last year about this, it seems there are loads of people with stories like this in the UK. I've had friends where the rental agents filled false complains about "marijuana smell" after a small disagreement. Really petty stuff.

The dispute service of the deposit protection services are completely useless as well. They took over 4 months to reply, didn't address half the stuff I had sent in, had no way to see what the landlord sent in, and made some spectacularly wrong decisions. The entire thing felt like it was rushed by an intern.

I think the problem is that as a landlord/rental agent you have a lot of power, especially in a high-demand market (I lived in Bristol). My apartment was listed as "let agreed" just 4 days after I left for £75/month more. Power corrupts.


I think it's just that you're not allowed to be sleeping outside. There are still about 200 actively homeless people (as in, sleeping outside) in Amsterdam, which isn't much for a city of around 1 million people. There are shelters, and there's the social net to fall in, in case you cannot afford to live or get medical help.

If you get cancer it won't mean you'll have so many bills you'll have to live outside. If you have disability, mental or otherwise, it doesn't mean you'll have to rely on the generosity of your family to be able to survive. And if you do sleep outside the police will likely make you not is my understanding.


Doesn't Amsterdam have a number of "squatters" living semiofficially in otherwise abandoned buildings?


That was a thing for a while to protest real estate speculators, but its considerable less now.


Wasn’t that in the ‘80s?


It exists, but there is not a lot of it, and it is not visible. I've often been asked for money for the homeless shelter, as far as I can tell, the municipal shelter really does cost money, though not a lot. Also, if I take a detour going home from work I come across a shanty town I'm pretty sure is illegal but tolerated.

A lot of this comes down to the municipalities though, which recently clashed with national politics on the subject of shelter for rejected immigrants. Some municipalities (including mine) wanted to provide bed bath and bread to these people. On a national level, the policy was to force these people to leave the country, as they were here illegally.

I imagine some of the more christian rural municipalities have a much harsher approach towards homeless people. It's probably effective as well, insofar as it pushes the homeless people out.

There has been a bit of an issue with what the police calls 'confused people'. These are the people with psychiatric issues that are a burden to people around them, but not enough to warrant forced institutionalization. Instead, every time something boils over, the police have to be called. It is very hard to get some of these people evicted, even when they routinely tear up their house and bother neighbors to the point of police involvement.

This is not a homeless issue though. Just one of psychiatric care.


Rates of homelessness in the Netherlands are overall the same as in the US.


Stastistically, there are twice as many homeless than in the US:

https://en.wikipedia.org/wiki/List_of_countries_by_homeless_...

Perhaps they are well-hidden?


But there are so many other options we aren't doing either!

We aren't offering treatment for free or even making sure there is enough treatment available. We are more likely to put them in jail for a small crime instead. Same with drug addiction: We tend not to offer free, medical based care and instead refer folks to AA or NA. I understand that some folks are helped by these organizations, but many are not.

We don't make sure folks have homes. Sometimes, simple solutions like driving a person to their home over and over is enough of a solution. If someone really wants to life outdoors, we could make room for such things while making sure things look nice and are secure.

We could have an actual safety net too keep folks from homelessness in the first place.

We can invest more in group homes as well, since some folks need help with everyday tasks. Some folks need this long term and some are just short term.

Have enough shelters for the folks that slip through the cracks. Make sure these shelters are safe for disabled folks, children, and everyone in between.

I know all this stuff costs money, and I'm more than willing to pay more in taxes so that folks are being fed and housed and have medical care and things like that. Honestly, we are paying for this stuff in one way or another anyway through our jail system, public services, and so on, so I'm not convinced it would have been that much mroe than it was when I was living in the US anyway.


> I'm more than willing to pay more in taxes

That’s a everybody should pay more taxes in disguise.

If it was only your taxes, nobody is holding you back to support a charity of your choice to do the job you want to be done.

But please let me support the charity of my choice instead of paying more taxes.


> I'm more than willing to pay more in taxes

How much more? I'm not trying to argue against what you're saying, but I believe that many Americans don't have a good idea of what it costs to run a Western European welfare state. What's the pain maximum for you? 10% more taxes? 50% more? 100% more?


As a European who's done the math several times over the last decade, my impression is that Americans in desirable states pay about as much in taxes (when you account for everything) as Western Europeans. For some things the results are better, for others they're worse, but overall I don't think there's all that much difference.


I don't know about other countries, but I've not seen the math come out in favor for Germany. 45% max federal income (with 43% quite easily reached), 19% VAT, high taxes on energy consumption. Even in high tax states like California, you don't usually reach those levels. Using the -yes, flawed- tax freedom day gives a pretty good picture, I believe.


Don't forget that in Germany your taxes pay for more services than in the US, like universal healthcare. Once you deduct out the cost of all the extra services that your taxes provide for you in Germany (and that they don't provide here), Germany wins. Healthcare is insanely expensive here in the US -- over $10k per person per year (so easily $20k per year for a family plan or more), some of which is born by employers.


The thing is that the taxes you pay in Germany don't pay for national defense - that's something that Germany gets for free by free-riding on US taxpayers. And the healthcare you get in socialized healthcare systems like the NHS or what they have in Germany is just barely sufficient - you could get the same deal in the U.S. by signing up with a HMO, and no one does because of how limiting it is. It's basically a wash, and the U.S., while worse at basic healthcare provision (due to pervasive regulatory capture in the whole system, which raises costs far higher than elsewhere) is still better at many other things.


> like universal healthcare

Nope, we pay that on top, currently ~14% of your salary (half of which is paid directly by the employer), the same goes for pensions etc. You do get free healthcare only if you're unemployed, but that's not reality for most Germans.


honestly, I moved from the states to Norway.

I'm pretty certain I'm paying the same or less overall. This is especially when I consider my healthcare is included in that tax. This simple things means I'm not as stressed as I would otherwise be.


I am American and moved to Norway. If you didn't know, Norway is known for high taxes and a quite extensive welfare system. I lived in Indiana. In neither place have I had a good-paying job.

But hands down, Norway is cheaper. Taxes include healthcare and my tax rate has been just slightly higher than it was total in the states, and many times lower than taxes + health coverage + deductibe + out of pocket.

There are lots of hidden consumption taxes: VAT is 25% on most things, 15% on food, but there is none on books and newspapers. A TV lisence is a thing. On the other hand, they try to make sure poor folks have internet and phone service.

I do think the top tax rate is about half of one's income, which is fine with me if I'm making more money. I'm fine with VAT and things like that.

The thing folks also forget is that some things are actually cheaper when centralized and spread out and coordinated. This works really well in health care because you can do cost evaluation on costs of covering a home nurse a few times a day vs a nursing home.

Americans also forget that one of the missing bits in American society is trust in the government. Folks here don't believe the government is perfect, but most of the bureaucratic bits just work, and lots of them are online and easily accessible.


I'm not arguing that a welfare state is a bad idea, I'm just saying that you won't get it for what you'd currently pay in the US. I believe that many people don't actually know what it would entail - for example that you'll typically land in a federal income tax bracket about double the rate compared to the US for a similar income if you're in Germany.

If it works out for you to live cheaper in Norway, that's great, but Norway has a very special position due to the vast oil wealth, that's not typical for Western Europe.

Also, I'd love for HN to stop flagging just because they disagree politically. It's so annoying to get timed out because of a civil exchange of arguments and opinions. Always look for light in the dark: this community has convinced me that direct democracy isn't a solution for moderation - it means giving the power to censor to those who are most willing to use it.


These numbers are absurd. There aren't nearly enough homeless people to drive taxes up by that degree; it'd still be well under 1% of your total tax burden. Plus, we're already paying for homelessness and mental illness anyway in the form of tax money that goes to the police, jails, and hospitals. A lot of people say that it would be cheaper to provide housing and support rather than continue the cycle of police, jail, and emergency medical treatment involvement.


> There aren't nearly enough homeless people to drive taxes up by that degree

Sure, but a welfare state isn't just about open homelessness, it's about free education, free health care etc as well.


1. You're setting a record here in moving goalposts.

2. Free public education has made this country what it is today. We wouldn't be one-tenth the world power we are now if we hadn't educated our citizenry to create a high knowledge work force. Killing off education and leaving the majority of the population uneducated would be the single best one change you could make to turn us into a third world country. It's the ultimate in short-termist thinking.


> 1. You're setting a record here in moving goalposts.

No, you're replying in a subthread that you didn't want to apparently. To quote myself: "I believe that many Americans don't have a good idea of what it costs to run a Western European welfare state".

> Free public education has made this country what it is today

Possibly. I think high skill immigration has also played a very strong role.

And again, since nobody is reading what I'm writing before flagging or angrily replying: I'm not arguing that a high tax welfare state is necessarily a bad idea. While I do believe that it creates bad incentives and has to be very well calibrated (which is hard and usually fails in my experience), that's not what this is about.

The point is that it does not come for free. You will have to pay for it, and you will pay via taxes. You should be aware of that, and I'm interested in finding out how much more people are willing to pay. The reactions I get (anger, disbelief, flagging) lead me to believe that people are vaguely aware of that fact, but don't want to face it. I suggest they do before they implement it.


Americans are currently paying more for an inferior product for no good reason at all.


That's because we'll gladly be gouged on prices as long as it's not called a tax. Internet? No problem there having zero alternatives in your area. Healthcare? Nightmare inducing and literally bankrupts people that even barely touch it, but it's not a tax.


Funny how it wasn't a problem in America until they made "One flew over the cuckoos nest."


I'm guessing it wasn't a problem that you talked about, just like everywhere else.


I think (2) is the more important of those two, as it increased the burden of proof. After all, narrator wrote “people who regularly randomly assault people for no reason“, which doesn’t sound like a mere harmless delusion.


Offering treatment for free is a good first step..


Do such people tend to believe they would benefit from treatment?


[flagged]


Why is it such an expensive place to live in then?


Californian software is eating the world


Artificial market constraints through rent control?


Coz international speculators don't care about the environment.


Speaking as 1) the son of a divorced mother on multiple antipsychotic drugs beginning in her mid-30s for schizophrenia, involuntarily hospitalized multiple times, who routinely discarded her medications as soon as she was discharged because of the terrible side effects, and 2) a retired physician (neurosurgical anesthesiologist x 38 years) who rotated through ERs and psychiatric wards during medical school and residency, then was occasionally paged to the ER to deal with critical airway issues/Code Blues in patients with psychiatric histories: people with major mental health problems are quite often prescribed medicines whose side effects are so crippling and difficult to live with, they'd rather do without. This is the root cause IMHO of much social vexation for the rest of the population. In addition, some homeless people, offered safe shelter and food in a controlled, supervised setting, refuse, fearing loss of freedom or worse. I see no solution that doesn't infringe on their rights as human beings.


Maybe psychiatry interns should spend a month taking antipsychotics, just to experience the side effects. It would greatly reduce their faith in big pharma.


Odd you should mention this: I have suffered a total of four major depressive episodes including my first at age 29, which culminated in a massive barbiturate/alcohol OD in a serious attempt to commit suicide. Lucky for me, while I was unconscious I vomited and fell out of the bed I chose to die in, landing face down. After three days on a ventilator in a coma, I woke up — still seriously depressed. Then I was transferred to the UCLA Neuropsychiatric Institute, where I spent the summer of 1977 and recovered, being discharged on several medications including an antipsychotic. I remained on the drugs for about five years, then went off per my psychiatrist's OK. I was started back on antidepressants and antipsychotics after I became depressed for the second time, in 1991. This time I was able to self-admit myself to a psychiatric hospital before doing myself any harm. I remained on antipsychotics for five years or so, then for the second time withdrew per my psychiatrist's OK. In 2001 my third depression happened, and the usual drug regimen was reinstituted, with the caveat that I needed to stay on them for life. I was fine with that until 2013, when I decided I didn't want to be on them even though for me the side effects weren't that bad. I spent the entire year slowly tapering off each of the four drugs I was on, one at a time. Sure enough, in January 2015, when I was finally drug free, my fourth major depression struck. This one was — by far — the longest, lasting 1.75 YEARS. Once again, onto the usual drugs, but after I recovered in October of 2015, I decided that I'm never again going to stop taking them. As regards Big Pharma, I am thankful for it: without the drugs — and their side effects — I would died a long time ago.


It's not just the side effects, it's also that antipsychotics don't really target the "negative" symptoms of schizophrenia such as anhedonia and avolition, which can be just as destructive to the prospect of a stable and fulfilling life as delusions and hallucinations.


You're spot-on. The hammer-type drugs/aka antipsychotics dull down everything.


>I see no solution that doesn't infringe on their rights as human beings.

It's not that hard - give them a flat and maybe some daycare. The rest of the world outside the US seems mostly to manage that.


>In addition, some homeless people, offered safe shelter and food in a controlled, supervised setting, refuse, fearing loss of freedom or worse.


The US seems to be coming to the realization that social welfare is not an altruistic indulgence, but a necessity for an economically wealthy society.

These library "residents" force the state - and its workers - to help them by confronting them with their sheer humanity. It is easy to refuse services to people you don't know, it's harder to send them out into the cold face to face. Most Human beings can't stand seeing another Human suffering. It just hurts us. Hurting them, by removing them forcibly, also hurts us.


But we won’t. We’ll sit here talking about how important it is to feel the full scale of the problem and how egregious it would be to deny these people any public space, and then we’ll go build maybe 12 supportive housing units.


Actually there are signs of progress.

Universal access to health care has become the majority opinion. As has the idea that locking up the mentally ill in prisons isn't really Ok. And that the current way the justice system works isn't really working.


Opinions are not progress. Policy, spending, facilities, and service delivery would be, if we had any.


There won't be improvement in spending and services until and unless the majority opinion is behind that.

Believe it or not, but the majority opinion in the US, especially among those who vote and given the unfair voting weights, was against even Obamacare at some point, much less to spend billions more on social welfare issues.

And part of that is the idea that taxing the rich and the companies will hurt the lower income workers. Many people don't want to tax millionaires because they fancy becoming one soon. Good luck...

Those attitudes seem to have changed, and that sounds like progress to me. Now get rid of the Cheater in Chief and vote for people who actually want to help the lower classes...


The big cities with substantial homeless populations are already dominated by left-leaning politics. It is not a question of getting more people to profess the correct beliefs, it is a question of converting those beliefs to specific actions despite their specific consequences. Like grandma losing her now-$2m house because its property tax bill reflects its value, or a shelter going in on your kid’s route to school.

It’s a consensus opinion in SF that we ought to tax millionaires. But we’re unwilling to touch the asset class where the millions are actually stored.

It’s a consensus opinion in SF that tax revenues should be used to help vulnerable populations stay in their communities. But “this is a community” is an ironclad argument that it’s an inappropriate location for any services or supportive housing.


Whats the solution? Throw another billion at the problem?

Have 80% of it get sucked up by the bureaucracy? And the other 20% is used on surface issues.

>social welfare is not an altruistic indulgence

Both sides want to help people, the great question is, what is the best way?

Should we spend 1B on bandaids? Or should we start earlier in life, giving people opportunities that keep them off the streets?


That's exactly the kind of "self-reliancy" and "small government" BS that hasn't worked for the US the past 100 years. Well, it has worked for a small minority which has increasingly enriched itself.

If you promote "giving people opportunities that keep them off the streets" as a solution, you profess to a total ignorance of how homelessness in the US (and most developed countries) works.

It's not poverty or lack of employment. It's more about mental health and substance abuse. You can offer those people all the jobs you want, without medical and psychological/social help, they don't stand a chance.

So yes, "1B on bandaids", like better mental health care for the poor, more social workers, more social housing would be a very good start.


Both. Some people will always need help and we need to man up and provide that help.


This quite touched me, I love libraries and when I traveled through the NA I often went in every big city to take some time from all the travel madness. The contrast between the libraries in Toronto and Seattle was quite stark. You could see the diffence between visitors, and there were a ton more homeless people in Seattle.

At the time i didn’t think much of it, but I was reflecting back on it after a awesome episode of 99% invisible (palaces of the people). The guest talked about how libraries changed and have a different function. And the importance of something he called social infrastructure as something that doesn’t get seen as important as let’s say, roads and electricity.

It’s Very related to what the author of the article is saying. We don’t nearly appreciate enough how libraries function in society. When we keep looking at as a buildings where you can get books and use the internet we totally miss the human side of it and if we don’t equip the people with the skills or experience to deal with it. They are going to be burned out.

Hopefully we can recognize the importance libraries have and support them in a way it benefits whole cities.


My only gripe about this story, is that they act like Public Libraries are the only places that have crazy people.

Working in retail making 7.85$/hr, we had plenty of crazy people.

There is something noble about being a librarian, and this article discusses that phenomenon.

There was nothing noble about serving enraged customers, customers that stole, or creepy customers.


There have been, and continue to be, social experiments proving that giving homeless people a house ends up being less expensive to communities and way more humane.

Maybe it's lack of understanding. Maybe lack of knowledge. Maybe selfishness. But it's doable, more efficient and decent.


Or maybe not even a house but just money:

https://www.washingtonpost.com/opinions/free-money-might-be-...

(I also submitted that as an own thread at https://news.ycombinator.com/item?id=19705704 )


Unfortunately the "but I worked for my money, so you can't give people money for free"-attitude prevents these sort of pilot programs from moving forward. Never mind that you're actually saving money, giving the homeless a better quality of life, and reduce nuisance for the rest of us.


One unintended consequence that you run into is that people for whom the program was not designed for and targeted to will actively try to consume it (e.g. an able-bodied person instead of a homeless individual with mental health issues). This, by the way, occurs today. There was a social worker from LA (I think) that talked about how big of a problem this is and how much drain on time, and resources it is in practice.

Because we live in a finite world, you're always going to be resource constrained, what happens is that you have to necessarily create a massive bureaucracy to triage and control who should and shouldn't get access to this program - which explodes the cost, and incentivizes cheating by those that don't get access. It also sets up an arms race, where you keep increasing the bureaucracy in order to control for new inventive ways that the program is abused, leading to more costs. I'm not sure if you're suggesting that property rights be given to the individual, or if staying in social housing is dependent on certain criteria being continually met. Either way, you're looking at more bureaucracy, and corresponding cheating, that again, explodes costs and creates new unintended consequences (for example, preventing able-bodied people from moving around to seek better opportunities, in the same way that rent-control does).

In other words, you'll merely recreate our present system. Writing a check is easy and if that was all that was needed, we'd have solved every societal problem a long time ago. There is no free lunch.


Do they get them of the streets, permanently? How about the neighbors?

Or how about we collectively got our shit together and realized that it is _not_ wrong to require certain things of people, and to enforce consequences when they don't obey them.


It's the idea that making someone else's life too easy is somehow immoral, especially if they obtain something valuable without the hard work.


People don’t usually see it as “making life easy is immoral” but as “making their life easier than mine is unfair”


You can always make their life easier by giving them YOUR money. Heck, you could even adopt them and house them in your own home. I would respect that. But I don't want one cent of my money to go to these kind of programs, and I think that my stand on this issue should be respected.


>I think that my stand on this issue should be respected.

But I don't think it's remotely worthy of respect. You want to live in a society like that, go somewhere with no public schools or roads or firefighters.


Do you want one cent of your money to go to farm subsidies, corporate welfare, or making defense contractors rich?


The last place TempleOS's Terry A Davis did a video before he died was outside a library.

https://www.youtube.com/watch?v=oH41gGBVpkE

"I really like this library. So uh, come here use their computer and smoke out here. They must have been freaking out because such an impure person was in their presence."


>>Money for low-income housing and social service programs has dwindled for decades.

This is not true. Money for low-income housing and social services has massively increased over the last 40 years.

The problem is, this approach is not working. The state psychiatric hospitals were closed because of the deinstitutionalization movement which was strongly supported by advocates of the mentally ill.

Now they don't want to acknowledge the consequences of that advocacy, and keep blaming the phantom menace of austerity and social spending cuts.


My wife started working at a downtown library 6 months ago. We live in a relatively small Midwest city (300K pop) that is a big college town, as well as the seat of the state government. Everything in this article is familiar to me; nothing is shocking in any way. This is the norm for urban libraries.


This is HN, home to some of the smartest problem solving minds. Is there a startup opportunity to make a dent in solving homelessness while also making a profit or is that wishful thinking?


I don't care for the idea that HN or programmers or engineers or doctors or NASA or any particular subset is home to "the smartest problem solving minds". I've met smart and creative problem solvers in all fields.

People tend to solve problems with the tools of their field, and it's telling that your first idea was "a startup opportunity". Really? Our solution for homelessness should also make a profit? We're going to bring our neighbors out of poverty by earning a buck in the process? Where does this money come from?

First, start by "doing things that don't scale": solve homelessness for one person. Then do it for 2, 5, and 10. My impression is that, like many human problems, a real solution might never scale.


"Our solution for homelessness should also make a profit?"

Profits are merely an incentive to getting more individuals involved and VC capital backing is unlikely unless there is an eventual ROI I'd imagine. How that ROI is determined is beyond the point, it could be government subsidies, cryptocurrency/blockchain related, etc.


Participating in the economy is the usual path to improvement of a population’s standard of living; it’s not outside the realm of possibility that it could work for this one.


How do you profit from people who can’t help themselves? Profit and necessary healthcare are not a good equation. A publically funded health organization is the best solution so far.


Having been lucky enough to grow up in Western Europe, in a “socialist” democracy, I’ve read a lot about the state of poverty in the US and been shocked by visits to San Francisco and Washington to see so many homeless people. I’d thought that seeing a street full or homeless people literally one block over from the Whitehouse was the most shocking thing - it is inconceivable in Western Europe that homelessness would be tolerated near a national monument.

But reading this, the idea that libraries are doubling as homeless shelters is the most shocking thing I think I’ve ever encountered about poverty in the US.

Sorry to provoke anyone from the US reading this but how badly does your society have to be broken to allow this to become an accepted norm? Given it’s an extremely wealthy country, the cruelty of the system that lets this happen is hard for me to even imagine.

This whole “survival of the fittest is what makes America great” crap needs to stop. Period. Because to me that seems like that’s the root cause, the excuse for treating a societies weakest so cruelly. The only discussion should be “how do we fix this?”.

OK rant over ... apologies to anyone triggered but genuinely shocked.


It gets worse. In my days as an attorney i had contact with people who arent allowed into public libraries. Think being homeless is bad, have pitty for those homeless also convicted of certain crimes. Many shall never again be allowed near a school, park, library or recreation center. They live under bridges without the option of visiting such friendly places.

It is easy to help the innocent. Real charity comes when asked to help someone you may hate.


What are some examples of those certain crimes?


Mostly sex offenders. Rape, assault, and anything involving children, but also some minor things. Public urination is a sex offence in some parts of the US.

The reality today is that most, think 90%+, involves purely online activity. These arent rapists. They are caught downloading stuff.


They are caught downloading images of children being raped?

Yeah, I reserve my sympathy for the children.


You can have sympathy for both?

Besides, it's not even about "sympathy", it's about preventing crime and general nuisance (like for the librarian in this article). I don't think anyone wins by making circumstances for sex offenders so hard they're living on the street. I'd much rather have these people in a safe environment with proper counselling/therapy.


I don't think you can have sympathy for both.

As for the rest it isn't just about forcing them to live on the street, ideally I wouldn't let them live in society at all, far away under a bridge is the closest I can get.


Maybe they should not have committed those crimes. Or are you suggesting they are unfairly punished?


Think of what these places offer. Schools provide structured education, parks provide nature, libraries provide knowledge, and recreation centers encourage physical fitness.

Now think of being barred from all of these opportunities. Yes, they committed a crime, and yes, it may not a good idea to allow them to mingle with other people sharing these facilities (especially if these people are children) but...where else does one go to improve oneself? You'd think, especially after being charged with a heinous crime, anyone who truly wishes to reform themselves would benefit from these places. But it is those exact people who are barred from doing just that, and the cycle repeats, because there is no way out.

I'm not saying there's an easy answer here, and it wouldn't be feasible to rebuild these places for criminals only. But these restrictions absolutely make it difficult to integrate and become a productive member of society again.


Of course they should not have committed those crimes, and their victims deserve justice.

But justice isn't served by making someone homeless and then preventing them visiting a library.

Importantly, that also doesn't help with rehabilitation or with preventing reoffending.

If you have a sex offender at risk of re-offending you want to know where they are and what jobs they have. That's made much harder if they're homeless.


People who have commit crimes are still people. Homelessness should not be used or seen as a valid punishment.


Homelessness is not their punishment. Not being allowed in libraries, schools, etc, is.


Do you think that's an effective deterrent? Do people go "better not download that inappropriately underage video, they might not let me in the library anymore"? And, if a punishment is not an effective deterrent - what's the point of it? What are we trying to achieve?

Going meta - your comments are all along the lines of crime and punishment and whether they "deserve" it etc. The replies to you are all along pragmatic lines - what we should do to make society behave the way we want. These approaches are incompatible - when the pragmatic approach disagrees with the fire-and-brimstone approach, ignoring pragmatism will by definition get a worse outcome. Your own feeling of righteous anger is not a good thing to optimize society around.

The notion of justice and punishment is a subsidiary mechanism to pragmatism - one of many ways to achieve a peaceful, stable society.

(One that does not appear to scale especially well beyond groups where everyone knows each other, or into deeply complicated and partially enforced rule sets. Don't kill your tribe member or the tribe will cast you out = effective. Don't exceed the speed limit or you might possibly receive a fine of some constant amount plus a proportional factor to the amount you exceeded it by = ineffective.)



I don't particularly feel bad for sex offenders. If you can't control yourself...


But you should try to discover the truth about them, or reserve judgement. The original dire presumed meaning of "sex offender" has been legally castrated (bad joke) in many states as shallow thinkers seize on the definition and its National implications to CHEAPLY hang any behavior THEY consider objectionable.

The most egregious misapplication (in my opinion) is "public urination", that is, being caught doing it by the wrong person, or if they consider you an unperson. Used to brand the homeless and turn them into national criminals by following them around with a camera.

Or human traditions under attack. A mixed group of adults and minors caught skinny dipping in the wild by the Wrong Deputy is another example. They'll nail the oldest and fill the younger with crushing guilt, if they are friends.

Consensual sex between teenagers is another. It's the ultimate glass-house throw stone legal abomination. And one or both gets the Scarlet Letter into their young adult years. Talk about a suicide trigger!

___

https://www.hrw.org/report/2007/09/11/no-easy-answers/sex-of...

"Most people assume that a registered sex offender is someone who has sexually abused a child or engaged in a violent sexual assault of an adult. A review of state sex offender registration laws by Human Rights Watch reveals that states require individuals to register as sex offenders even when their conduct did not involve coercion or violence, and may have had little or no connection to sex. For example:

"At least five states require registration for adult prostitution-related offenses;[108]*

"At least 13 states require registration for public urination; of those, two limit registration to those who committed the act in view of a minor;[109]

"At least 29 states require registration for consensual sex between teenagers;[110] and

"At least 32 states require registration for exposing genitals in public;[111] of those, seven states require the victim to be a minor.[112]


People get put on sex offender lists for urinating in public. Not saying that's what happened here but it's worth considering before passing judgement.


If they can't control themselves we really don't want them wandering around the streets, we want to know where they are. Constant monitoring is an important reoffending protection measure for some sex offenders.


You want to know where public urinators are?


> IF THEY CAN'T CONTROL THEMSELVES

bold added.

This comment about sex offender lists being full of people who had a single piss in public, but whenever I've asked for evidence people post maybe three or four examples.

Feel free to show me research that these public urinators aren't people flashing to children.


Yeah, how else can we use big data to figure out where to build new public toilets?


I consider that to be a cruel and unusual punishment.


Yes, that sort of indefinite exclusion from public locations is certainly unfair. "Cruel and unusual", even, from a Western European perspective anyway.


> it is inconceivable in Western Europe that homelessness would be tolerated near a national monument

There are two options for that: a) solve homelessness b) send in the police to make sure the homeless stay where you can't see them.

I don't know about other Western European countries, but neither is done in Germany. You will see homeless people in Berlin near monuments. Maybe Berlin is an exception, but I have some doubts.

> Given it’s an extremely wealthy country

I always have huge problems with statements like these. What makes a country wealthy? The size of the federal budget? The amount of debt? The private wealth of the median citizen? The number of billionaires? And even if you find a country to be wealthy while having social issues - how much should it invest, and how should it prioritize, and who should be paying the extra taxes, or which other parts of the budget do you want to reduce? I don't believe in the "wealthy country" meme in a "look, you have lots of money, why don't you just buy a new pair of pants" way.

> The only discussion should be “how do we fix this?”

I'm certain that nobody sits there and says "Listen, we must not fix this, otherwise we lose our edge". It's just hard to fix. You can temporarily make homelessness disappear by simply throwing money at it, but you won't solve it. Homelessness in general isn't so much a financial problem as it's a mix of mental health, drug abuse, bureaucracy, broken housing markets and certainly many more factors.


> it is inconceivable in Western Europe that homelessness would be tolerated near a national monument.

Name the country. I have lived in many cities and towns across Europe. I know that homelessness is tolerated one street down from Edinburgh castle, next to the parliament building in Budapest, in front of the Deutsches Museum in Munich, in the stations of Rome, and don't even get me started on Brussels.


So have you been to San Francisco or other big US cities..? A typical discussion you would have with other expats there was right what the post said: That the degree of homelessness and its ignorance are shocking.

These European cities you name are no comparison to SF. Brussels is known to be one of the more shoddy, dangerous places in Europe, I've been there very recently (i.e. even with many refugees who have fallen out of the system on the street) and it still did not compare to the degree of homelessness that can be seen in SF. I have yet to find a whole downtown street full of homeless people in Europe.


You don’t need to go to America for that - I live in Berlin and visit SF on occasion and didn’t get the impression there are more homeless people in the latter (nor that it is dirtier).


I also live in Berlin and occasionally visit SF. The homeless present differently, as does the dirt. In Berlin there is more graffiti, but the homeless can make money picking up glass and plastic bottles for the Pfandgeld. (And as an Auslander, finding spent blanks everywhere after New Year was a big schock).


I remember leaving the subway for downtown SF, at Union Square for the very first time. My first impression of SF was playing slalom with all the homeless people right on the street. I've been living in southern SF for four months and often saw a saddening amount of poverty that most people just seemed to ignore. I also regularly saw homeless people that were so mentally ill that they appeared very dangerous (especially for a female).

Berlin's homeless people become most visible when they enter the subway to politely tell their story and let people know why they need to beg for money. In terms of danger the organized beggar-robber gang type (which are not really homeless people) may be on the rise, but this is no comparison to what could be seen in SF. While there is the occasional lunatic you have to avoid, you usually just feel pity for Berlin's homeless people. There is also, without doubt a relatively stronger social net that can catch more of these human beings.

You may also want to check out www.crimemapping.com for more "cultural differences".


The homeless problems in America have absolutely nothing to do with “survival of the fittest” and your comment is nothing but stereotypes. US cities spend massive amounts of money on social issues and the US is in fact the world leader in terms of donations as a percentage of GDP.

https://en.wikipedia.org/wiki/List_of_countries_by_charitabl...

The homeless problem is mostly attributable to laws in the 70s and 80s which released mentally ill patients from hospitals and prevented their future incarceration.


> The homeless problem is mostly attributable to laws in the 70s and 80s which released mentally ill patients from hospitals and prevented their future incarceration.

This is an over-simplification of homelessness that doesn't bear much scrutiny.

Many people develop mental ill-health after, not before, becoming homeless. Many people are homeless without "severe mental illness" (schizophrenia, bipolar).

https://www.bbrfoundation.org/blog/homelessness-and-mental-i...

> According to a 2015 assessment by the U.S. Department of Housing and Urban Development, 564,708 people were homeless on a given night in the United States. At a minimum, 140,000 or 25 percent of these people were seriously mentally ill, and 250,000 or 45 percent had any mental illness. By comparison, a 2016 study found that 4.2 percent of U.S. adults have been diagnosed with a serious mental illness.

Looking at the common disorders we can see the causal direction could easily be "the misery of homelessness causes the mental disorder".

> Affective disorders such as depression and bipolar disorder, schizophrenia, anxiety disorders and substance abuse disorders are among the most common types of mental illness in the homeless population.


Donations as a percentage of GDP is a terrible metric when comparing with countries where caring for the disenfranchised is seen as the responsibility of the government and almost wholly funded by taxes.

It's absolutely stunning that there is > 1.5 million non-profits in the US, and one has to question why?

Looking at a bunch of them in the homeless causes, and seing that it's not unusual at all that the chief executives of tiny non-profits receives $100 000-$200 000 in compensation which in many cases is 4%-7% of the expense budget, one might be tempted to think that many of the non-profits and their donations are based more on economy than empathy.


The US also spends a lot of money on healthcare, but it doesn't really work, because the model is flawed.


Yes well that means that the system is broken, not that Americans have some sort of “too bad, the weak should die” mentality (as the OP suggested.)


The “too bad, the weak should die” mentality is, unfortunately, very much the impression I get whenever discussing healthcare with Americans. It’s easy (availability heuristic) to forget this says more about the sort of Americans who are likely to engage in discussion about healthcare than about Americans as a whole.


The main thing I've noticed, as someone who works at a company too small to have cheap insurance and is too well off to get subsidized insurance, is that people who work for big companies genuinely don't think health insurance is a problem in America because their employer is able to get bulk plans where they are paying something like $100 a month out of pocket for absolutely amazing coverage.

Then you have the people who used to have great coverage, but it's slowly gotten less good and more expensive over time. They are mainly worried about doing something that will make the problem even worse.

Then you have people like me, who are paying ridiculous money for what is basically "catastrophic" insurance, and like to complain loudly any chance we get, mostly on deaf ears because people hope the problem won't come their way if they just ignore it and carry on.


Interesting perspective, thank you.


So why hasn't the broken system been fixed (or at least brought up to the standard of the rest of the developed world) yet?


Political donations from for-profit insurance companies.

A political ideology centered on market fundamentalism and individual responsibility (eg. "The free market is always more efficient than government provided services", "Why should I pay for your poor choices in life?").


Capitalism is a system of the survival of the fittest, materially, in that people have to subject themselves to the vagaries of the market and sell their labour to acquire they means of life, and culturally, in that people are primarily valued according to their market worth.

European countries have tried to offset the marketisation of human life and society through universal healthcare, labour regulations, and (mostly) generous welfare systems. The US does not have universal healthcare, has few of Europe's labour regulations (e.g. mandated working hours, holiday time, sick and paternity leave) and spends half as much on welfare programmes. It would be astonishing if that had nothing to do with American homelessness.

The fact that Americans donate a lot means nothing in particular in this context. Little of that goes toward creating a working healthcare and welfare system, or changing the basic moral fabric of American life. The largest share goes towards religions, as I understand it.


That's not capitalism. That's the world. You don't eliminate competition and materialism by making private property illegal. You just make competition less socially beneficial. For example your energy is diverted to gaming a welfare program, or lobbying for more benefits for the disadvantaged group you are a member of, instead of creating a company or product that raises everyone's productivity.


That statement would only hold if capitalist market relations were a universal feature of every facet of human life, and if humans were driven only and voraciously by self-interest. But neither of those things are true.

Economics is one sphere of human life, alongside culture, society, politics, and ethics and religion. The relative importance of these spheres is not fixed, but changes over time. One of the aims of the welfare state is to constrain capitalist market relations in order to make room for other spheres of life, for democratic control, family and community, moral values, and cultural creativity.

You appear to be claiming that humans are, always and everywhere, solely moved to maximise their material interests. That has no anthropological plausibility whatsoever, and reveals a deep misanthropy on your part. Contrary to your suggestion that welfare claimants comprehensively exploit the system, official statistics in the UK state that only about 2% of claimants do.


Competitive impulses are not "capitalist". They predate capitalism. In other words, they exist in the absence of "capitalist" laws.

There is no evidence or indication that competitive impulses change as a result of changing or eliminating laws that provide people security of property and contract liberty. When you repeal those legal protections to forcibly redistribute income, you just cause people to find new ways to compete, like minimizing the taxes they pay (people in the US spend $265 billion a year attempting to minimize their tax exposure) or maximize the benefits they receive. And those ways are much less beneficial to society.

>You appear to be claiming that humans are, always and everywhere, solely moved to maximise their material interests.

No I'm saying that to the extent that they do try to maximize their own material interests, that will not change by changing the laws relating to private property rights.

>Contrary to your suggestion that welfare claimants comprehensively exploit the system, official statistics in the UK state that only about 2% of claimants do.

You can't actually measure successful fraud, and moreover, expending energy on maximizing welfare benefits isn't limited strictly to committing fraud. There are ways to increase welfare benefits that are legal and both unethical and socially detriment, like having additional children when you already cannot independently support the ones you have.


I am not sure what you are arguing against.

The original post to which I responded argued that homelessness has nothing to do with the 'survival of the fittest'. I argued two things. First, that it does insofar as capitalism is based, structurally and psychologically, on the transformation of humans into commodified labour to be sold on the market. Second, that the welfare state is an attempt to try and offset the human cost - deprivation, precarity, unemployment, exploitation - of the marketisation of social relations.

In response to what you said.

(1) 'Competitive impulses are not capitalist'. I never mentioned a 'competitive impulse'. I made the trivial claim that, (a) economics is one sphere of human life among others, and has no necessary priority over them; (b) that humans are moved by more than material self-interest. Both of those claims are compatible with the idea that humans are generally, and to varying degrees across history, 'competitive'.

(2) 'There is no evidence or indication that competitive impulses change as a result of changing or eliminating laws that provide people security of property and contract liberty'. You are reifying human psychology. Humans do not possess fixed and determinate 'impulses', apart from for simple objects like food, shelter, water, and sex. Humans are distinguished from other animals by their capacity for non-genetic learning. We create cultural meaning through language, art and social practices. These accumulate over time. Ultimately this dominates human behaviour and history. That means that you can rarely explain complex social behaviour by reference to fixed features of human psychology. We vary over time according to our social conditions.

The general idea that humans manifest the same competitive behaviours regardless of social conditions is comprehensively refuted by history. Do you really think pre-historic tribes, fifth century BC Sparta, and feudal Japan instantiated the same competitive dynamics as modern capitalist societies?

(3) 'No I'm saying that to the extent that they do try to maximize their own material interests, that will not change by changing the laws relating to private property rights.'

This is very vague. 'To the extent to which they do try to maximize their own material interests' leaves unstated how and to what extent humans maximise their material interests.

In response to the substance of your statement, let's imagine two scenarios:

Scenario 1: 'X' has to work 50 hours a week for the means of survival and, if she fails to do this, becomes unemployed, or suffers health problems, she faces death.

Scenario 2: X works 36 hours a week for a legally mandated minimum wage. If she is fired she is entitled to unemployment benefits. If she falls ill she has access to healthcare that is free at the point of use.

I take it to be patently obvious that X in scenario 1 is moved by material self-interest to a greater extent that is X in scenario 2. For in the first scenario it is a question of survival, whereas in the second case she has the time, ability and security to significantly give herself to extra-economic activities - culture, politics, morality and religion, society and family.

P.S. 'contract liberty' is a wonderful euphemism.


>>First, that it does insofar as capitalism is based, structurally and psychologically, on the transformation of humans into commodified labour to be sold on the market. Second, that the welfare state is an attempt to try and offset the human cost - deprivation, precarity, unemployment, exploitation - of the marketisation of social relations.

I'm saying that people are always going to be mired in materialist competition with those on the losing end seeing relative deprivation.

That is a property of the world, not of capitalism. I didn't even mention the inflammatory slavery-associated characterization of people choosing to sell services as "the transformation of humans into commodified labour to be sold on the market."

Welfare doesn't eliminate deprivation, it just changes the avenues through which deprivation emerges.

>>(1) 'Competitive impulses are not capitalist'. I never mentioned a 'competitive impulse'.

Yes you did, here:

>>That statement would only hold if capitalist market relations were a universal feature of every facet of human life, and if humans were driven only and voraciously by self-interest.

The self-interest drive is what I'm referring to by "competitive impulse". It contrasts with the communal impulse of working for the common good.

That will not go away by virtue of eliminating laws that provide people with security of property and contract liberty (aka "capitalist" laws).

>>(2) 'There is no evidence or indication that competitive impulses change as a result of changing or eliminating laws that provide people security of property and contract liberty'. You are reifying human psychology. Humans do not possess fixed and determinate 'impulses', apart from for simple objects like food, shelter, water, and sex. Humans are distinguished from other animals by their capacity for non-genetic learning

Humans absolutely do possess innate impulses. Humans share 96% of their DNA of chimpanzees, 90% of cats, and 85% of mice. We are not fundamentally that different from other animals, and numerous studies demonstrate the massive influence that innate traits play on our behaviour.

For example, numerous studies have shown that the Big Five personality traits have an approximately 50% hereditary factor. And the other 50% are cultural traits that are not going to be wiped away by some radical social engineering project , since they are passed on through micro-interactions and social dynamics far beyond the reach of the state.

You are far more likely to cause havoc in any attempt to socially re-engineer mankind than you are to do any good. Social interventions are generally much more likely to have negative unintended consequences than produce desirable results, because existent social dynamics often exist for good reasons that are not obvious to a superficial analysis like the kind produced by simplistic ideologies. Cultural traits and dynamics emerged over long periods of time through a process of iteration, and it is folly to recklessly try to re-engineer them based on a crude ideological assumption about the world.

>>This is very vague. 'To the extent to which they do try to maximize their own material interests' leaves unstated how and to what extent humans maximise their material interests.

That's not relevant to my point, and it's not something I can answer anyway, because I, like you, have no way of knowing. My point is that there's no indication that human impulses would be changed by changing economic laws. They are far more deeply ingrained than you give them credit for.

To assume otherwise is a reckless form of optimism about any coherent plan to re-engineer a large population's impulses, in order to rationalise very radical social engineering project that could and likely would cause terrible suffering.

>>I take it to be patently obvious that X in scenario 1 is moved by material self-interest to a greater extent that is X in scenario 2. For in the first scenario it is a question of survival, whereas in the second case she has the time, ability and security to significantly give herself to extra-economic activities - culture, politics, morality and religion, society and family.

That's overly simplistic. You don't raise wages by increasing the minimum wage. If it were that simple, we could make everyone wealthy with absurdly high price floors on labour.

Price floors harm the economy for reasons economists have exhaustively detailed.

You will also pay a price in per capita GDP from taxing and redistributing income. If reducing income inequality were as simple as redistributing income, reducing poverty would be trivial: just tax and redistribute 100% of income.

A higher income country with less redistribution can provide a higher quality of life to the very poor than a lower income country with high levels of redistribution. That's why reducing poverty over longer time frames is not as simple as redistributing income. The effect of redistribution on income growth has to be factored in.

The empirical data suggests that the best way to raise per capita GDP is with free markets not interfered with by disruptive government interventions like price floors (minimum wage) and income redistribution programs.

And how long do you think your welfare programs are going to work for the poor? Highly productive people will find ways to escape the clutches of your redistribution program. A social system in which the producers are coerced to giving up a massive share of what they produce is not sustainable.

You run the real risk of training your hypothetical woman to become dependent on the government, have children as a simple mother on the assumption that she will receive child benefits, and then see the economy implode, the government cut back services, and she and her children be left without the means to take care of themselves.

As for contract liberty being a euphemism, you wouldn't be saying that if the state imprisoned you for entering into a contract with another consenting adult.


>'Welfare doesn't eliminate deprivation, it just changes the avenues through which deprivation emerges.'

Deprivation is the lack of material things. People without universal healthcare or benefits systems in unpropitious circumstances will have neither healthcare nor shelter and food. Ergo, welfare alleviates deprivation. That follows logically. It is also the incontrovertible historical picture. I have heard many arguments against the welfare system, but I have never heard anyone argue that providing people with life-saving medicine or food to eat makes them materially worse off. I don't know by what ideological self-contraption you have been able to convince yourself of that.

>'I'm saying that people are always going to be mired in materialist competition with those on the losing end seeing relative deprivation. That is a property of the world, not of capitalism... Humans absolutely do possess innate impulses. Humans share 96% of their DNA of chimpanzees, 90% of cats, and 85% of mice. We are not fundamentally that different from other animals, and numerous studies demonstrate the massive influence that innate traits play on our behaviour.'

Once again, this is under-specified. I am arguing that one of the roles of the welfare state is to create the basis for humans to give themselves to non-economic activities: to culture, community, politics, ethics, and so on. That is compatible with the fact that humans are to some extent competitive. You seem to be saying that humans are sufficiently competitive that this would only displace their competitiveness into new domains. But you have shown nothing of the sort.

You claim that we have innate impulses. I wouldn't use the word impulses, but I agree that there is such a thing as human nature. You say that we share most of our DNA with chimpanzees, cats and mice. That's true enough. But then you leap from these two platitudinous claims to the idea that human nature is both fixed and determinate. I see no reason whatsoever to believe that.

Take two of the strongest genetic determinists that I know of. Steven Pinker argues in the The Better Angels of Our Nature that our psychology is made up of a number of dispositions and that human history consists of our changing our environment such as to change the balance and strength of those dispositions. In other words, our psychology is majorly conditioned by our social conditions. Robert Plomin, the world's leading genetic determinist, argues - and his claims are far stronger that most geneticists - that even physical traits like height, weight and eyesight are only partially (30-70%) accounted for by genes. In other words, neither of them claim anything like what you seem to be arguing: that we have fixed dispositions (not dispositions which change in balance and strength) which strictly determine (not tendentially shape) human behaviour. I happen to disagree strongly with both Pinker and Plomin for the reason I gave previously. Humans are radically different from other animals because non-genetic learning - culture, norms, social practices, meaning - accounts for more of our behaviour than our genes do. Hence why human change occurs in historical time and not, like other animals, in evolutionary time.

>'That's overly simplistic'.

You are changing the question. We are talking about whether humans are always and at all times moved by self-interest in the same way and to the same degree. In my scenario they are clearly not. I note that you do not disagree with that judgement, i.e. you implicitly concede that in that hypothetical those two people are moved by self-interest in different ways. Instead, you claim that that scenario is impossible. I would engage with your reasoning but it's a red herring - it is nothing but misdirection from the relevant question.

>'As for contract liberty being a euphemism, you wouldn't be saying that if the state imprisoned you for entering into a contract with another consenting adult.'

This is rhetoric. It is both possible to think that 'contract liberty' is a euphemism that conceals the fact that many contracting parties do so from structurally asymmetrical positions, and to think that arbitrary imprisonment is wrong. What you are saying depends on the theory of negative liberty first propounded by Thomas Hobbes, where liberty is the absence of physical interference. I take that to be manifestly wrong. We don't want to be interfered with, because we want to be able to do things. But negative liberty only secures us the former, not the latter. For example, it does me no good if the police permit me to use the train to see my family if I don't have the money to pay for the train to see my family, if I am starving to death, or if I need to work all hours of the day to keep a roof over my head.


>>Deprivation is the lack of material things. People without universal healthcare or benefits systems in unpropitious circumstances will have neither healthcare nor shelter and food. Ergo, welfare alleviates deprivation. That follows logically.

That is far too simplistic. Like I said, a higher income country with less redistribution can provide a higher quality of life to the very poor than a lower income country with high levels of redistribution. That's why reducing poverty over longer time frames is not as simple as redistributing income. The effect of redistribution on income growth has to be factored in.

>>It is also the incontrovertible historical picture.

Every measure of deprivation was improving faster before the creation of large welfare programs than after their creation, so no, it not the historical picture at all.

>>Once again, this is under-specified. I am arguing that one of the roles of the welfare state is to create the basis for humans to give themselves to non-economic activities: to culture, community, politics, ethics, and so on.

Of course if you're looking to dismiss all of my points, you can demand an unrealistic level of specification and dismiss anything that doesn't meet it. I'm being more specific than you.

I was addressing your argument that human nature is totally malleable. It absolutely is not.

>> I am arguing that one of the roles of the welfare state is to create the basis for humans to give themselves to non-economic activities: to culture, community, politics, ethics, and so on.

Non-economic activities are not non-competitive. You won't make mankind less competitive by creating a forcible income redistribution scheme. You will divert that competitive energy into avoiding having one's income redistributed to others, and trying to maximize how much income is redistributed to one's self. That is reality, and wishful ideologies do not change that. Ignoring that reality leads to disastrous social consequences.

And social status competitions emerge in all sorts of situation not involving money. You don't reduce competitiveness by equalizing the distribution of reportable income and consumption of remunerated services. Competition just emerges in other areas, like developing social connections to get to know the right doctors to get better quality healthcare.

>>But then you leap from these two platitudinous claims to the idea that human nature is both fixed and determinate. I see no reason whatsoever to believe that.

I didn't say it was totally fixed. I said: "numerous studies have shown that the Big Five personality traits have an approximately 50% hereditary factor. And the other 50% are cultural traits that are not going to be wiped away by some radical social engineering project , since they are passed on through micro-interactions and social dynamics far beyond the reach of the state".

>>We are talking about whether humans are always and at all times moved by self-interest in the same way and to the same degree. In my scenario they are clearly not.

There is no evidence or reason to believe that redistributing reportable income changes the extent to which people are moved by self-interest.

Perhaps people having more material resources will allow them to focus on things other than survival - which is not the same thing as not being moved by self-interest, or not being competitive - but redistribution of income does not lead to people having more material resources over any extended time frame. It will lead to people having less material resources.

>>This is rhetoric. It is both possible to think that 'contract liberty' is a euphemism that conceals the fact that many contracting parties do so from structurally asymmetrical positions, and to think that arbitrary imprisonment is wrong.

You're making blanket judgements about contractual interactions instead of letting each interaction be judged on its own merits by a court of law. Courts will invalidate contracts which are deemed to not be genuinely consensual. Your assertion that parties with unequal levels of wealth are not able to enter into consensual interactions is the kind of overly-simplistic generalization that is produced by crude ideologies like socialism, that cause so much pain and suffering in the world.

"Contract liberty" merely means people are free to enter into contract with others that are deemed consensual by courts of law. Courts aren't perfect, but they are far more discerning than an ideologically-motivated cookie-cutter rule that generalizes entire classes of interactions as non-consensual.


Welcome to Belgium, Europe. Our Library doubles as a homeless shelter too. Shelter shortage.


I'm not sure about other European countries, as I live in Spain. Here the situation is different. NGOs and the Catholic Church maintain a network or homeless shelters were people are fed and can sleep for free. The government subsidize these organizations instead of focusing on solving this problem itself.


It is shocking and I agree with most of your sentiment.

I'm not sure the issue is "survival of the fittest" mentality though. I think it may be more the idea a person is an individual and can do as they please. That idea is deeply ingrained in America like it's not in many parts of the world, including Europe. The actual laws sometimes don't reflect the idea (for example the draconian laws on drug use vs massive amounts of drug use that actually occurs on the ground in the USA).

It's an idea I agree with, and it has some serious benefits in terms of productive capacity and potential for achievement, but taken to extremes, the idea manifests in some pretty ugly ways. It's not that there isn't help for the homeless, more that no one is enforcing help or otherwise structuring life for people. Add to this the pursuit of wealth by whatever means necessary destroys community and aggravates the situations that produce homelessness.

I'd also like to point out America is indeed a land of immigrants. Many of these have been from the lower or disadvantaged classes or otherwise people who just didn't fit in with their previous societies. Much of the time they did indeed achieve a better life for their children but sometimes the generational cycle of irresponsibility and squalid behavior didn't disappear upon touching down on new shores.

Just my theories. Not sure of accuracy. But it is a shocking state of affairs and shouldn't be as it is.


And who are you to dictate what "needs to stop"? This is not tumblr. Your language and tone are not productive. Please suggest solutions and have a civil discussion!

Perhaps I'll start:

I think this is tragic but the average American feels totally powerless to help. In San Francisco the homeless are almost all mentally ill, often dangerous, people from other states. My suggestion would be to pool money from all cities they come from and fund homeless programs outside of SF, outside of metropolitan areas. Then, transfer the homeless there and give them another chance to restart and get the help they need outside of a revolving door urban environment.


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