Hacker News new | past | comments | ask | show | jobs | submit login
People with severe mental illness have been failed by a dysfunctional system (theatlantic.com)
281 points by fortran77 on April 11, 2023 | hide | past | favorite | 312 comments



On one hand I want to be sympathetic to the author here, who has personal stake in preventing the severely mentally ill from murdering people. At the same time, the author doesn't at all go into the deeply personal and often traumatic reasons the mentally ill may resist being forcibly hospitalized in the way the author suggests should be done to them. The author doesn't go into cases like Brittney Spears's conservatorship, forced to take medication and have an IUD inserted and have her estate taken over by her parents under spurious claims of being unable to care for herself. The author doesn't go into how little oversight there is over ensuring the safety of patients once they're in the healthcare system, many of which go on to develop medical trauma due to rape, assault, etc.

There has to be some kind of middle way where people who are deeply sick can have healthcare even if they are resistant and also heavy guardrails in place to prevent them from being abused while they're vulnerable.


> There has to be some kind of middle way where people who are deeply sick can have healthcare even if they are resistant and also heavy guardrails in place to prevent them from being abused while they're vulnerable.

The only guardrails that work to prevent abuse are community connections and the right to refuse.

In clinical treatment, many human rights abuses are normalized to the point where people being abused believe that's just what treatment is without someone outside the system to provide perspective (and usually abuse will continue without someone to advocate alongside the person being abused).

It's just an obvious matter of course that people who can't say "no" will become objects to the treatment provider. Without some counteracting force, providers will manipulate people in their care to satisfy their own incentives and convenience.

If people don't want treatment, we should ask what's wrong with the treatment, rather than forcing people into it. It's rarely helpful and makes things even harder down the line.


> If people don't want treatment, we should ask what's wrong with the treatment

This reasoning works with most illnesses, including most mental health problems. But it sort of falls apart with psychotic illness. A common symptom of schizophrenia is a denial of any illness, or ill-functioning. In extreme cases, an individual may show no appreciation of the fact that e.g. being socially isolated and with no income will probably quickly kill them. I'm usually the advocate for the agency of people -- I do point out the opposite in another post in this thread, that many people with schizophrenia are aware of their illness and impairments, because many are. But many are not. Even with truly perfect treatments with no side effects that completely cleared delusions and clouded thinking, many, because of their illness, would choose not to take such treatment.


The awareness can also wax and wane within a single individual. A friend of mine has been forcibly hospitalized several times and the trauma inflicted severely impacted his desire to seek treatment during his more aware periods.

When I finally got him to reach out to care providers (since as just a friend, there was no way to setup inpatient care as an intermediary) they made it so difficult for him to enroll that no only did that moment of clarity pass without getting treatment, it also burned up whatever status as an ally that I still had with him.

So while changes to commitment laws absolutely can be part of a solution, they must be paired with deep introspection into the despicable failures of our mental health system to provide appropriate care. Otherwise we risk inflicting additional trauma that will make managing future crises far more difficult.


>When I finally got him to reach out to care providers (since as just a friend, there was no way to setup inpatient care as an intermediary) they made it so difficult for him to enroll that no only did that moment of clarity pass without getting treatment, it also burned up whatever status as an ally that I still had with him.

That is tragic. There is no ready alternative when health care providers fail.


SF's favorite game is to send ambulances out to a guy sitting on the street, screaming insane things, covered in his own feces and trying to punch people. Ambulance shows, guy says "No!" and so everyone says "Oh, this person is doing just fine, leave them alone." And everyone leaves, and the guy goes back to covering himself in his own filth and shouting at people. Definitely a great outcome for all involved.

If the people advocating for the homeless and mentally ill have a better solution than leaving them on the streets to rot, then I would like ot hear it. Because 100% of the solutions proposed in SF amount to "Leave them alone, they are fine." So fucking sick of it. It is VERY clear when someone needs help, but our society would rather let them suffer in the streets than do anything. Anyone who tries to help or suggests getting them off the streets is a fascist.

Homeless advocacy in the Bay Area amounts to "Maintain the status quo, do nothing to help. Punish those who try to take back their own homes and streets from people covered in filth and perpetually addicted to drugs and violence." SFFD former captain who was beaten senseless this past week in SF is literally in the hospital while 2 of the 3 people who beat him with a crowbar remain on the streets. Even when these people are violent, we do nothing. KRON4 interviewed one of his attackers on TV! Guy's still in his camp on the streets, still angry and dangerous. Attack is even on camera!

We live in a society where those who follow the laws are constantly punished for minor infractions like parking tickets and zoning violations, while people who do not participate in society AND completely flout the laws in every way are not only allowed to do so, there is a huge section of our population that encourages and protects their right to do so.

It is supremely infuriating to watch the Bay Area be so completely backwards and so utterly dogmatic as to ignore problems and constantly attack people for not being progressive enough. We literally have conservatives disassembling democracy across this nation, and the Left's favorite game to play is "Can we castigate more progressives for not passing the acid test."


> SF's favorite game is to send ambulances out to a guy sitting on the street, screaming insane things, covered in his own feces and trying to punch people. Ambulance shows, guy says "No!" and so everyone says "Oh, this person is doing just fine, leave them alone." And everyone leaves

The flip side of this is forcibly transporting people to hospitals and slapping them with $10-15k bills for a glorified taxi ride.

Homeless can't pay that, so small wonder they're left there. But you or me? No sir, you're unable to make decisions for yourself; we absolutely need to take you in for evaluation.

Your wallet is biopsied on the way to the hospital, where the real fun starts.

Be very afraid of an America with forced medical "care."


I dont know why you are downvoted but bad faith compliance is absolutely a thing. whats to stop city from sending such a patient to nearby private hospital in the name of 'medical necessity'. who decides who needs to forcibly hospitalized? if you fall into a puddle and somebody calls an ambulance would you rely on the ambulance driver's judgement to decide if you need the $10k ride to hospital?

with healthcare you always have to think about bad faith operators because there is zero transparency and no free market there.


> if you fall into a puddle and somebody calls an ambulance would you rely on the ambulance driver's judgement to decide if you need the $10k ride to hospital?

In the US, the fire department shows up first and administers first aid. Private transport to the hospital is arranged after that if needed.

The problem is all the advance-fee bullshit. You're billed $1000 per minute starting with your occupation of a gurney, and that doesn't guarantee you will receive any sort of treatment once you get to the hospital. If you're not destined for a trauma ward, you'll sit in a room for six hours, be discharged without even a diagnosis (or the lolworthy "mild concussion"), and have incurred a debt equal to the cost of a new car for the experience.

These days, you don't even get a bottle of Oxy as a consolation gift-- you get nothing.

It's exploitative even when good faith operators are involved.


>would you rely on the ambulance driver's judgement to decide if you need the $10k ride to hospital?

$10k for an ambulance ride? Is there any documentation for that claim, or is it just hyperbole?

According to the San Francisco Fire Department[0], an ambulance ride is ~$2400 (which includes lifesaving services), plus $46/mile[1.61km].

By my calculation, an ambulance would need to transport a patient ~165 miles (266km) to make an ambulance ride cost $10k.

For some perspective, It's ~160 miles from San Francisco to Fresno[1].

I'd expect that San Francisco EMTs don't deliver patients to Fresno, or even outside the San Francisco city limits[2]. Since San Francisco is 46.9 sq miles (121 sq km) in area, a $10k ambulance ride is incredibly unlikely at best.

N.B: I do not live in the Bay Area. It took less than 30 seconds to confirm the costs above via DDG. Not sure how GP (and others) came up with a number 400% higher.

[0] https://sf-fire.org/services/ambulance-billing

[1] https://www.distancecalculator.net/

[2] https://en.wikipedia.org/wiki/Nota_bene

Edit: Added Nota Bene[2].


That's for services rendered by the SFFD. But there are plenty of private ambulance companies that charge whatever they charge. You don't get to say "no thank you" if you are unconscious.

For example, when my family were involved in a car crash on the freeway in Los Angeles some years ago, even though the local fire department arrived at the scene within minutes, their paramedics did not. My two kids were taken to hospital in separate private ambulances. $6k each.


This comment is hopelessly obtuse. Most Americans can't even afford a $1000 emergency expense; the $2400 expense you cite is already unaffordable. Add in any ER fees the hospital charges -- which can easily be part of what GP refers to -- and you'll probably get to that $10K figure anyway.

Don't believe me? Here's what happened right here in SF when a bicyclist with a broken arm was taken to the local public hospital, SF General:

"A few months later, Dang got a bill for $24,074.50. Premera Blue Cross, her health insurer, would only cover $3,830.79 of that — an amount that it thought was fair for the services provided. That left Dang with $20,243.71 to pay, which the hospital threatened to send to collections in mid-December."

> came up with a number 400% higher.

A moment with a calculator would show you that the number GP uses is 300% higher, not 400% :)

https://fortune.com/recommends/banking/57-percent-of-america...

https://www.vox.com/policy-and-politics/2019/1/7/18137967/er...


>This comment is hopelessly obtuse. Most Americans can't even afford a $1000 emergency expense; the $2400 expense you cite is already unaffordable. Add in any ER fees the hospital charges -- which can easily be part of what GP refers to -- and you'll probably get to that $10K figure anyway.

I didn't say there weren't problems with the system, or that most folks (let alone homeless folks) could afford such things, but 400% more than the published cost? That's hyperbolic and, more importantly, incredibly imprecise.

I see you disagree with that. I agree that you disagree with me. Have a lovely day.

Edit: removed extraneous text.


It's not hyperbolic at all.

Here[1] is an article on the top stories on HN right now where a couple was charged 200k for a rabies shot.

Posted prices here in the US are complete bullshit, as any medical code transcriber could tell you, or indeed anyone who's been to a US hospital and had to pay out of pocket.

I once went to the emergency room at 1am. It was almost empty, no one walking the floors, but still took them 4 hours to get to me.

They never checked my vitals or my weight, the doctor looked down my throat with a wooden stick, gave me one generic 200mg ibuprofen and sent me on my way.

My bill was $3500.

Their reasoning when I fought it? 'we only have very generalized codes and that's how we determine what to charge.

Literally did nothing but waste my time and charged me 3500 for the privilege.

I told them they wouldn't see a dime and I'd happily see them in court over it (no idea if I could even take them to court but I was beyond pissed).

Bill was dropped to 250,which to me was still outrageous for a freaking ibuprofen (dollar store knockoff brand to boot!).

Over one dollar per milligram of OTC medicine.

This was now 15 years ago and the prices have done nothing but increase since.

[1] https://news.ycombinator.com/item?id=35532458


>Bill was dropped to 250,which to me was still outrageous for a freaking ibuprofen (dollar store knockoff brand to boot!).

Yes, medical billing in the US is hopelessly opaque. And I've had an even more egregious experience[0] myself.

However, that $250 wasn't just for the ibuprofen and tongue depressor. It's for the physical plant, infrastructure and other operating expenses as well. Although the largest portion of that is likely the cost for the time of highly-trained personnel (nurses, doctors, etc.).

How much do you earn in an hour? No. Don't tell me. I don't care.

But I'm sure it's more than zero, right? Would you work for zero dollars an hour?

If not, why are you ignoring the costs of paying hospital personnel?

Not sure why you went to an emergency room. Those are for, wait for it...emergencies. Was it an actual emergency? If not, they should have charged you even more.

[0] A physician to whom I was referred posited (incorrectly) that a skin lesion might be infected with MRSA[1] and insisted that I go to the hospital for testing and immediate IV antibiotics. I reluctantly (as I -- correctly -- believed that wasn't the case) did so. I was in the hospital for three days (the length of time -- at least they claimed it took that long -- to test for MRSA), after which time I was told (shocking...not!) that I was not, in fact, infected with MRSA and discharged. I received a bill for something like $100 and an "explanation of benefits" (EOB) from my insurance company. The "total cost" listed on the EOB was ~$12,000. Out of curiosity, I perused the detail and found that I was being "charged" for being in two hospital rooms at the same time (a neat trick, I wish I could replicate it) as well as having had a Pap smear[2], despite not (ever) having a cervix.

I complained to the insurance company that there was obvious fraud going on. They responded that I shouldn't worry my pretty little head about it because I wasn't paying anyway. That made me even angrier and I demanded that this be investigated and addressed. A few days later, I was involved in a conference call with the insurer and someone from the billing department of the hospital in question. The insurer and the hospital went back and forth (performatively, I soon found) about billing codes, but when I pressed them on how I could possibly have had a pap smear when I don't have a female reproductive system, they finally fessed up and told me that the contract between the hospital and the insurer capped hospital stays/services at $500/day, and that the stuff in the EOB was complete bullshit.

Just as the $3500 on your bill was complete bullshit. But $250 actually seems reasonable for an emergency room visit. Even with health insurance, I'm subject to a $150 co-payment for emergency room visits -- just for walking in the door and signing in.

[1] https://www.mayoclinic.org/diseases-conditions/mrsa/symptoms...

[2] https://www.mayoclinic.org/tests-procedures/pap-smear/about/...


Wow I'm sorry that happened to you. Truly.

Yes I am paid for the work I do, but I wouldn't expect to be paid for the work I am supposed to but dont do.

warning this will be a bit graphic/gross

A bit more context on my event: I had an abscess on the upper part of my jaw that had my entire face swollen and a fever of 102+ when I went in. I was shaking all over with chills and sweating like I was in a sauna.

They let me sit there in agony and never checked my vitals. Not my temperature, not my blood pressure- nothing.

I begged them to lance it, anything. Ice for the swelling, even. Nothing.

It was so bad after being in the hospital 4+ hours I went home and the abscess grew so bad it drained out the bottom of my tooth root.

I could very well have died. And they used a fucking tongue depressor and handed me a 200mg ibuprofen.

That was why I was so upset with the bill.

I get it there's doctors and infra to pay for, but not for doing nothing, especially when we had free clinics in that city that could have helped me had it been normal business hours.

I've paid thousands for stiches and complained, but at least I got the stiches, so I shut up and paid. I had slag get in my eye that had to be dug out with a needle. My eye was numbed, they removed the shards (the slag cooled when it hit my tears and shards were embedded in my eye). That cost me a grand total of 750. The penicillin eye drops they prescribed? 500 before I think it was goodrx where they have deals on scripts and I think I got them for 50.

Point being they make this up as they go and there's zero reason for it to ever change.

Edit for more color- the abscesses event was at an ER in a hospital that most definitely had the capability to at least get me to an actual doctor in the hospital side rather than keep me in ER. And this was before the prevalence of these new Emergency centers as I'd have gladly gone to one of those instead.


Wow. That's horrific.

I'm sorry you had to go through that as well.

That's awful care. I had a similar situation (not in my mouth, but on the nape of my neck. A sebaceous cyst that was infected and swollen.

This was only a couple years ago and I actually went to one of those "urgent care" centers. They took one look and said "nothing we can do, you should go to the emergency room." For which they charged my insurance company $1800 (of which I was billed ~$200 -- money those assholes will never get, I might add). So those folks aren't necessarily the best choice either.

So I did go to the emergency room and was ushered into an exam room within an hour. They did examine it and me and actually got the on-call resident from the surgery department to open it up and drain it.

It helped a lot, but they did a half-assed job and I had to go back for more cutting/draining. Even now, the sac that the sebaceous cyst grew from was not removed (GRRR!) and I will (probably this year) have it removed and the site closed up properly.

That's much better than your experience, but still not that good.

It was still a few thousand dollars, although my insurance paid most of it.

But whatever hospital you went to should be named and shamed, because they didn't do (provide adequate care) what they were supposed to (and billed for) do. That was awful and you have every right to be angry -- but it's almost certainly not worth legal action -- and more's the pity.

The bigger issue (IMHO) is less about quality of care (although as we've both experienced, that can be quite variable -- and that's certainly an issue) is the business model around health care in the US.

Which makes accessing health care and understanding the costs much more difficult than it should be.

I'm all for a single-payer system or, as they have in Germany (at least IIUC), private insurers that are non-profit by law.

Unfortunately, that's unlikely to happen here -- as the insurance (and healthcare) lobby will push hard to maintain their profits -- sucking resources from the system that could instead be used to provide better care.

And the current model also encourages consolidation, which harms small communities the most (see this joke[0] for context), since there isn't a whole lot of profit to be made, and hospitals have expensive infrastructure requirements.

[0] source: https://motd.ambians.com/quotes.php/name/freebsd_fortunes/to...

   On his first day as a bus driver, Maxey Eckstein handed in receipts of $65.
   The next day his take was $67.  The third day's income was $62.  But on the 
   fourth day, Eckstein emptied no less than $283 on the desk before the 
   cashier.

   "Eckstein!" exclaimed the cashier.  "This is fantastic.  That
   route never brought in money like this!  What happened?"
   "Well, after three days on that cockamamie route, I figured business would 
   never improve, so I drove over to Fourteenth Street and worked there.
   I tell you, that street is a gold mine!"

Edit: Fixed formatting. Removed extraneous text.


For reference, a bacterial culture cannot be declared negative in less than 72 hours. That's the source of your three-day admission, although that's an odd beast - if you're stable, you can go home on oral antibiotics in most cases with an early followup.

The "rules" of medicine are often quirky and very frequently frustrating (to both patients and doctors) - but they're rarely random.


>For reference, a bacterial culture cannot be declared negative in less than 72 hours. That's the source of your three-day admission, although that's an odd beast - if you're stable, you can go home on oral antibiotics in most cases with an early followup.

Yeah. The doctor who visited this horror on me seems to have been a really bad doctor. Which is also why I changed GPs after this because he recommended this moron.

I'm not a physician, but in 2008 when this was happening, I asked about oral antibiotics and was told they were ineffective for MRSA. That may have been ignorance or a lie. Or, perhaps things have changed in the past 15 years. I have no idea.

Prior to hospitalization, he'd prescribed a topical sulfa drug (which, unknown to me until then I was allergic to) which made things much, much worse. In fact, I have permanent damage and discoloration to the skin on my leg. And I developed hives on the palms of my hands and the soles of my feet. It was a disaster -- but that wasn't the doctor's fault -- I didn't know I was allergic.

After that debacle, I went to see a vascular specialist (the other guy was a "wound care" doctor), who suggested a compression stocking[0]. The lesion was completely healed in five days.

Now I take a much more active approach when I have medical issues, having learned (the hard way) that I need to be my own best counsel when it comes to my health. That includes research, asking questions, making sure I have the relevant information to make appropriate medical decisions for myself.

[0] https://health.clevelandclinic.org/what-you-should-know-abou...

Edit: added the missing link.


> That's hyperbolic and, more importantly, incredibly imprecise.

In common USA English, use of a figure like "10K" suggests imprecision - it's a magnitude of order ballpark, a gesture at the logarithmic scale.

This convention is useful because it's easy to remember a rough ballpark, but precise figures are going to quickly get muddied in details.

It seems strange to complain about imprecision when someone has already clearly indicated that they're talking about a rough estimate.


>In common USA English, use of a figure like "10K" suggests imprecision - it's a magnitude of order ballpark, a gesture at the logarithmic scale.

Really? As a life-long resident of the US, native US English speaker, and the child of a native US English speaker and a long-time resident of the US from another English-speaking country (UK) (both with post-baccalaureate degrees), I never heard that from anyone except you.

Not teachers in primary or secondary school, nor in college. Nor have I seen that in any of the many usage guides I've read over the past half-century or so.

Yes, "Forty days" in the Abrahamic[0] tradition is meant to be imprecise (i.e., meaning "a long time"), but the bible/torah/quran aren't guides to modern English, are they?

Perhaps you could enlighten this American ignoramus as to the correctness of US English idiomatic phrasing in this light. It would be most appreciated.

[0] https://en.wikipedia.org/wiki/Abrahamic_religions

Edit: Clarified prose.


I'm really not clear what you're asking, so all I can say is that nice round numbers are usually a ballpark estimate, while more precise figures suggest some actual calculations were involved. To be a bit technical: if there's only 1 significant figure, then you should take the number with a fair amount of salt.

Unfortunately social rules like this usually aren't well documented. It's mostly a statistics thing: very few calculations produce an exactly even result, so more often than not someone has rounded things off.

If you want to get really fancy you can start using context and tone to further infer whether someone is throwing out a ballpark estimate or a precise number, but that's well beyond the scope of a HN comment


>that's well beyond the scope of a HN comment

Exactly my point. And even if I wanted to, there's wasn't any tone or context to draw on -- just a flat assertion.

I'd add that, at least to me, a "ballpark" figure would be something reasonably close to an actual value e.g., $25 ballpark vs. $27.99. In the case to which I replied, it was more like "ballpark" $25, actual $9.99. Which "ain't the same fuckin' ballpark, it ain't the same league, it ain't even the same fuckin' sport."[0]

[0] with apologies to Quentin Tarantino.

Edit: Added an additional thought and some context.


It would come down to the law to dictate who has the final say in sending someone to a hospital. Or else the people making the decision they shouldn't be making open themselves up to being subject to legal punishment. (Which opens up another question of who can afford to...?)

The free market could incentivize bad faith operators even more because of the greater potential of the profit motive. Free market doesn't necessarily mean greater transparency or ethics.


There is a public hospital called SF General where people who can’t afford medical care are treated.


If someone is punching people, that's a legal issue. That's not really something the medical system has tools to address.

To the rest of your scenario, no one says they're "fine". Just that the person has the right to choose no medical treatment. You also have that right. If a doctor says you will certainly die without treatment, you can say no. The doctor doesn't write in the note that you are fine, just that they offered and you did not want it. It's not a "game", it is the ethical and legal requirements of the role.

You assume your proposed intervention will "help", but what is your basis for that claim? What signals should they be looking at to guide the course of treatment? For doctors, the answer can be vital signs, tests, but those don't help here. Usually, they're looking at patient input.

> If the people advocating for the homeless and mentally ill have a better solution than leaving them on the streets to rot, then I would like ot hear it.

Properly funded, voluntary community treatment. It is possible to design services such that people want them; I've seen it (yes, even people experiencing psychosis). You have to train providers in engagement skills and actually empower the person receiving services. Traumatizing them with regards to health care is not going to help.

Fixing it requires and robust social safety nets at the federal level. A municipality cannot do it alone.


>Just that the person has the right to choose no medical treatment. You also have that right. If a doctor says you will certainly die without treatment, you can say no. The doctor doesn't write in the note that you are fine, just that they offered and you did not want it. It's not a "game", it is the ethical and legal requirements of the role.

The issue is that the people we're talking about don't have the mental faculties to make these decisions. Do you think someone in the state they're in, barely even aware of where they are, unable to even speak or stand up straight, would be allowed to sign a legally binding contract? Of course not, any court would throw out any contract they signed because they're obviously not mentally able to make decisions like that. Same goes for decisions about their health.


>Ambulance shows, guy says "No!" and so everyone says "Oh, this person is doing just fine, leave them alone."

No, no one says 'this person is doing fine'. It's 'we're medical staff and we can't arrest people - they are clearly withholding consent, we can't do anything else'.

I've stayed with distressed homeless people trying to hurt themselves while social worker teams, cops and medical staff came to the scene; if the homeless individual doesn't want help and is not an active danger to others there's very very little that can be done to forcibly detain them.

> If the people advocating for the homeless and mentally ill have a better solution than leaving them on the streets to rot, then I would like ot hear it.

Fund shelters and support groups well enough that trying to get off the streets and get help doesn't require that you bunk next to someone who has a shiv and is experiencing a massive heroin withdrawl event while you try to sleep. There's a reason homeless people dodge a lot of so called 'help'. It's because the help is often worse than the alternative.


I've befriended and fed a certain individual in south San Jose who would stand on a the corner of Bernal and Santa Theresa and yell at the air. Anyone familiar with the area knows who I am talking about.

He is extremely lucid most of the time. And a very grateful and warm hearted individual. But he cannot for the life of him access any services, food stamps or healthcare or anything. The police can't even help him. They all know him. No one seems to be able to help him. I've fed him and been his friend, I don't know what else I can do.

He has no ID nor way to get ID.


Longtime resident here (15 years). It's easy to become frustrated with the complex and persistent issues of homelessness and mental illness in San Francisco. However, it's important to acknowledge that there are numerous groups and individuals who are passionately working to create positive change in the lives of those affected. They're offering essential services, advocating for policy changes, and developing programs to tackle the systemic issues that contribute to homelessness and mental health challenges. It's simply not true that homeless advocates and organizations just want to maintain the status quo.

Second, it is not a question of punishing those who follow the law, but rather addressing the systemic issues that contribute to homelessness and mental illness. By focusing on parking tickets and zoning violations, you're missing the bigger picture of societal inequality, lack of affordable housing, and inadequate mental health care. This isn't about passing a "progressive acid test", it's about practical solutions that work and are politically feasible.

Lastly, your comment oozes contempt for people who are struggling with addiction and mental health issues. Labeling them as "people covered in filth and perpetually addicted to drugs and violence" is not only dehumanizing but also incredibly counterproductive. We must work together to find compassionate and effective solutions, rather than resorting to name-calling and finger-pointing."


> Because 100% of the solutions proposed in SF amount to "Leave them alone, they are fine."

The mayor actively supports changes to state conservatorship law that would allow authorities to force people into treatment.

https://www.sfgate.com/politics/article/san-francisco-treati...


> SF's favorite game is to send ambulances out to a guy sitting on the street, screaming insane things, covered in his own feces and trying to punch people. Ambulance shows, guy says "No!"

Roughly - without the violence - a friend watched this precise scenario last fall in Spokane, WA. If the person had been within hospital grounds, the paramedics & security could have restrained them under grounds of inability to make choice, given them medications, and maybe helped them some. But, since the person was a block away from the hospital, there was no ability to say, "buddy, you have feces all over you and are laying with flies all over. we're gonna take you in, hose you off, launder the clothes, then see what we can do for your mental state". That would have been the kindest thing to do.

The crux is that certain "out of your mind" states require external intervention, and there is no legal way to apply that in many jurisdictions today. Note that some jurisdictions require a trial-like apparatus for involuntary holds after some 24/36? hour period - I don't that's inappropriate at all. Being able to see a guy laying covered in filth and take him in to help should be legal; at least for 24 hours. The indigent will have their debt forgiven - hospitals know they don't get blood from a turnip.

It is true that some medications don't work for everyone, and some medications produce horrific side effects. So there is some % of people for whom the best medication regimes today do not work. That has to be considered and reflected through. It's also true that there's high correlation with addiction and homelessness. That all has to be considered and addressed.

Considering institutions. As I've had a good friend for a long time with mental illness who has been in wards, the quote from the article is very true.

> I disliked the hospital, but even with its heavy locked door, I knew it wasn’t a branch of the “carceral state” devised by a power‑mad society to torment him.

And this has to be understood by everyone who thinks through this. Mental wards in the United States today are not, conventionally, torture chambers for mad doctors. They are restrictive and often frustrating, for reasons that a little thought should reveal. Aberrant nurses and arrogant & high-handed docs exist there, but they are not, systemically, the norm. It is not a horror movie.

TBQH, I don't think the vast majority of mental health writings online by non-experts touch on severe mental illness in anything approximating a realistic way.

The status quo is really quite unacceptable. My druthers would be to re-institutionalize and keep a very high legal and regulatory scrutiny on the institutions. Other solutions might work well too. But a key cornerstone of improvement will have to come to changing the shape of the law for involuntary holds and medication for people in high crisis.


> Mental wards in the United States today are not, conventionally, torture chambers for mad doctors.

I've worked on an inpatient psychiatric unit, and while the doctors might not be "mad", it absolutely is torture. The most obvious example is sleep deprivation, which is definitely torture. This is done in the name of "helping" the person (by checking on them), but makes things so much worse.

> My druthers would be to re-institutionalize and keep a very high legal and regulatory scrutiny on the institutions.

This does not and can not work for reasons outlined in my original comment. The system claims to be helping but shuts down any feedback mechanism that would suggest otherwise. There's just no way to square that circle.


> I've worked on an inpatient psychiatric unit, and while the doctors might not be "mad", it absolutely is torture. The most obvious example is sleep deprivation, which is definitely torture. This is done in the name of "helping" the person (by checking on them), but makes things so much worse.

Checking on them how often?

Is it worse than a normal hospital?


You might benefit from looking at personal experiences of what a psych ward is like. There's a furry comic called Fresh Meat about the partially fictionalized experiences of a teenaged girl in for attempted suicide, where one of the beginning sections she is forced out of bed from a dead sleep in order to be transferred to another ward by being shoved out of bed and then when she's asked not to be touched the nurse tells her there's much worse that can be done to her besides touching. She is also withheld food and water until she signs a consent form that allows her to be kept indefinitely, but also she cannot leave the facility on her own will because she's in a psychiatric hold.


Thanks for sharing that. Great comic - read it straight through. :)


I am sympathetic to stories like those, and I don't doubt that bad things happen, but it's important to recognize that people suffering from serious mental illness are often unreliable narrators. It's a difficult situation.


Question: if a non-psychotic psychiatric patient cannot be trusted to perform first-hand accounts of their own abuse, and psychiatric wards are tightly controlled such that lawyers and patient advocates can only be allowed in when deemed reasonable by the hospital, how does a sexually assaulted patient navigate reporting their abuse?

Believing that all patients, regardless of their exact illness, cannot be trusted to accurately describe abuse done to them is precisely what enables abuse in the first place. Suicidal thoughts is not a condition where you cannot tell if you're being taken out of bed in the middle of sleep. Suicidal thoughts is not a condition where you cannot understand someone is threatening you.


I really don't know.

With the caveat that this is just an anecdote, one of my family members is an extremely intelligent and highly accomplished man. He graduated from Yale law, worked at a very high level in the executive branch, and during his professional career, I don't know anyone who questioned his character. Retired, he is now suffering from severe intractible depression.

Last month, I drove my relative to a doctor's appointment, and due to his own mistake, he showed up at the wrong time. And on the wrong day. Since I had walked him into the office, I heard his conversation with the receptionist, and then with his doctor, who came out to calm things down.

On the ride back to his house, my relative phoned another member of my family and angrily explained what had happened. He blamed everything on the doctor, and made baseless accusations against the doctor and receptionist. My relative's account of the situation wasn't based in reality. And he related his account right in front of me. He truly believed every word he was saying. But it wasn't true. I saw what had happened with my own eyes. I heard it with my own ears. I, fortunately, am well.

It wasn't the doctor's fault, nor was it the receptionist's fault. Quite the opposite, my relative had made a mistake. His illness, however, — depression — blinded him to that reality. And his reaction was to sling baseless accusations at his doctor.

Like I wrote before, this is a really difficult problem. I don't have a solution. I wish I did.


Figure every 15 minute someone looks through the door to make sure you didn't harm yourself. Mileage might vary by ward and illness.

Some wards are noisier than others.

I've heard of a camera in-room as well. Better for disturbance, worse for privacy.

Note that these people in acute inpatient wards are in a serious crisis: attendants _have_ to make sure they aren't hurting themselves.


>The indigent will have their debt forgiven - hospitals know they don't get blood from a turnip.

Lol I was taken involuntarily to the hospital. When they gave up billing me they simply turned it over to collections to let them deal with squeezing the blood from the turnip. (not mental though, fraudulent accusation by federal agents I had drugs up my ass and then dragged there in handcuffs).


>We live in a society where those who follow the laws are constantly punished for minor infractions like parking tickets and zoning violations, while people who do not participate in society AND completely flout the laws in every way are not only allowed to do so, there is a huge section of our population that encourages and protects their right to do so.

At the end of the day it's inconvenient to punish homeless for crimes. They have no money, they're often infected with disease, and they are often unpleasant to deal with. Meanwhile when I did absolutely nothing wrong, federal officers bragged to me what a great vacation it was to drag me to the hospital for the better part of a day on a fraudulent and fabricated search for "drugs" because they said it was better than doing their normal beat, and it paid great overtime. People say you should be polite to law enforcement, but the fact is being unpleasant/unpolite/filthy works.

Like most humans, a frightening amount of law enforcement boils down to they did it because it was easiest. Dealing with mentally ill people at their worst moments is not easy, extorting a well to do professional for going 5 over the limit is much easier.


> We literally have conservatives disassembling democracy across this nation, and the Left's favorite game to play is "Can we castigate more progressives for not passing the acid test."

I have to say, a rant like that about how things are in SF ending on that note caught me off guard. You explained in detail all of these problems and closed out that you’re worried about conservatives?

I have to ask…why?


The "left" as practiced in SF fails to get anything done and lets things fester and worsen through neglect.

But... the evangelical/nationalistic right, on the other hand, comes out and says exactly all the things they want. Less healthcare, less regulation of the powerful, more cops for the less well-off, more weapons, less sexuality that they don't like, etc. "Fixing mental health" isn't in that list. "Building more housing" isn't even on that list. There are a LOT of people with good reason to be scared of those moves.

Tell me which of these I should think is more feasible:

1) Working with democrats to add some practicality to how to get to the desired outcomes I support?

2) Trying to convince the right that they should change almost all of their goals?


I might be accused (by some) of being on the right.

It's not that I don't want to "fix mental health". Who wouldn't want to wave that magic wand and be able to justifiably claim to be the savior of what I sometimes read is as high as 20-40% of the population of our country?

That said, I feel like it's a problem that can't reasonably be solved by anyone. Not because they're unwilling or incompetent, but that the science just isn't there. Everyone today wants to solve infectious disease, after all. And we actually manage (sometimes) to accomplish that. But if the year were 800AD and you complained that those in charge weren't solving the perplexing miasmas and dark humors that were making people sick with the black death...

You'd have been a fool. No one knew how to deal with those things then. And no one knows how to do something about mental health now. There seem to be medications that sometimes help some people, but when they don't work (or when they do!) no one can give a straight explanation why. The psychologists fail to give us a working theory of the human mind such that we can (even hypothetically) understand why someone is schizo. Or depressed. Or has OCD.

Don't get me wrong. I am not blaming the left for not fixing this. It's just intractable. Everything I see suggests it's likely to remain so into the indefinite future.

Both sides should stick to "building more housing" if you ask me.


The point of SF's progressive movement is to fight back against conservative policies with an example of what progressive politics can accomplish. It's not exactly working out now is it? SF itself is the city where all of the beautiful progressive ideas come together in harmony and make a heavenly place. It is absolutely incorrect in that assessment of itself. Spend 5 minutes at a city council meeting and you will see exactly what I mean. Same thing happens in Oakland. The city spends an awful lot of time commenting on what's going on in conservative areas and passing rules and laws that seemingly address those things but are really just talk. And then they continue to ignore the real problems of crime and homelessness. Oakland and SF love passing support statements for people having issues in other states, but can't get their own Police Departments to even show up to do their jobs. Priorities are entirely wrong.


There are a lot of people on the left who have never ever liked conservatives or republicans but who are extremely frustrated at what the left is doing. They seem to be failing on a lot of things, and conservatives seem to be succeeding, but whenever we criticize the left or suggest something other than what the current thing is in progressive circles, we’re called fascists.

More importantly though, it kinda sucks you focused on the tribal aspect of the comment because it was full of other things to engage with.


It was simply the part that surprised me the most. I’ve heard so much of the rest of the topic that the poster’s mindset was the newest information from my perspective.


I'd guess that the idea is that left wing politics in a lot of places has gotten bogged down in ridiculous notions of "just do whatever you want, everyone has kindness within them" and lets that override the normal concerns about cohesion and wellbeing in society.

You can have socialism, redistribution, a progressive society etc., whilst also recognising that no, you can't just park your tent wherever you want and bother people.

You can support the fact that people might have unorthodox sex lives in private whilst also believing that people who parade the fact that they "have multiple genders" are attention seekers.

The best way that I can describe the feeling I have is that effectively, there's no "upper bound" for compassion/empathy in the modern left-wing framework and that crashes and burns when it hits the real world.


You worry about conservatives destroying Democracy but all of the most desirable places to live for people who aren't rich enough to afford private segregation are conservative areas. Are there any liberal areas where it's actually nice to live if you are poor or of moderate income? As in not wealthy enough to afford, doormen, gated communities and private schools?


It's hard to answer this question if we don't have any examples of what you think of as conservative "nice places to live." The affordability bar varies wildly even in red states, and you also have red state/blue city stuff going on a lot.

So I'll turn the question back like this: what do you think are nice places to live that have demonstrated effective solutions to affordability and mental health problems at scale in a relatively dense city with high property prices from high demand?

In my experience, the way this is "fixed" in a city like Phoenix is a combination of: "be able to sprawl outward further and further without yet getting completely blocked by geography so there's always somewhere to put new construction to keep costs down" and "have inclement weather that pushes the homeless out so we don't have to be the bad guys ourselves as much" - but these are basically the opposite of the most common proposed "if only the government could get it together" fixes for SF: denser construction and confinement. Those tools are likely necessary for a city like SF, but it's not like there are Republican cities showing how to get it done.


Massachusetts (and most of New England) is great. I own a large house with a mortgage that's cheaper than a shared studio in San Francisco and I never worry about locking the door.

Neighbors are all friendly, well behaved kids roam the street unsupervised, it feels the same way it did 30 years ago here. It's deep blue territory. The weather is terrible and the Red Sox have gone off the rails, but you can't have everything.


Ok, so can you be more specific that's a large reason, but my understanding was it's very expensive there? So what is an average home price like, and is there any significant diversity diversity? Massachusetts as a whole looks to be as much as 80% white.


There is a huge range, parts of Boston and the NYC suburbs that extend into CT might compete with San Francisco on astronomical prices (and real estate market absurdities) and parts of Maine will compete with anywhere in the US for cheapness.

The average is not as meaningful here because there are places all along the scale (except in Boston, again, kind of crazy there, but there are commutable suburbs with fairly reasonable prices).

No place is going to have the same diversity, fun, or nice weather like San Francisco. Certainly not in New England. That why it sounds like studios are going for $2500 or more there and I have a 3bed2br house for less than half that here.

The cool thing is I'm 15 minutes from downtown Worcester, 45-60 to Boston and Providence, and 2.5 hours to NYC. I find that I get out in one city or another about as often as people who live there, but am also able to take more trips internationally because I'm not spending a fortune on housing. But if you're the kind of person who really is taking full advantage of what a place like San Francisco has to offer then it probably does make sense to live there.


> Are there any liberal areas where it's actually nice to live if you are poor or of moderate income?

Lots of the Great Lakes Region. I live in a liberal area where the average house price is ~150-200k and I rent a 2 bedroom, ~1000 sq. ft. apartment in the middle of the city within walking distance to things for $950.


Ok, that realistically is the kind of answer I am looking for. Thanks, can you give any more specifics because great lakes region is pretty large.

Though I also think you may benefit from a bit of the weather being inhospitable to most of the poor and homeless.

Also what is the diversity like?


Mid sized cities in the region are very habitable, diverse, and reasonably priced. Indianapolis, Columbus, Cincinnati, Lansing, Green Bay, Springfield, etc. The big cities are harder but still better than the coasts, $$ wise. I think Milwaukee is reasonable, though.

Diversity will vary a lot. The manufacturing cities are pretty diverse: My city is about 60 percent white and 40 percent POC.

They do lean more towards 'working class' liberal than 'professional' liberal. More 'rah rah unions' and less Ibram Kendi. Though if you're in a university city or capital, both are decently represented. If you meant other than racial, I haven't had a problem being gay in any of those areas since the mid-00s and a lot of those cities have small but thriving immigrant populations and the cities are small enough that there is political diversity coming in from the burbs/rural areas.

I feel like those areas are more diverse than the big big cities I have lived in. (Boston, Seattle, Vancouver).


Maine, Georgia, Michigan (anywhere but greater Detroit)

Hint: all of these places are solidly purple (but voted blue in 2020 so I counted them). It's like having actual political competition is a good thing!


> If the people advocating for the homeless and mentally ill have a better solution than leaving them on the streets to rot

The comment you are replying to put forward exactly such a solution: that treatment should be helpful enough and sufficiently respectful of users' rights, that people who need it don't refuse it.


You can't reason the person smearing shit on themselves and screaming at people into treatment.


The eagerness to reason from the headline anecdata on this topic is a signal that it is not just the mentally ill who exhibit severe thinking problems.

No, you can't reason with that one person at that moment. Get them sedated, cleaned up, new clothes and a haircut, and then ask them what is going on with them.

For each one like that there are another 10,000 people in various forms of quiet desperation.


> Get them sedated

Kind of tough to get them to that first step willingly. Got any other ideas?


<del>Willingly was your idea.</del> As for other ideas, some are in the comment.

What about the 10,000 who might be willing if society offered them treatment options even a sane person would accept?

EDIT: because sibling comments are willfully ignoring my point

EDIT2: public disturbances are frequently halted with police arrest, not whatever willingness could be brought about ahead of time with better systems in place


We used to fairly easily commit people to asylums. There was lots of abuse of this power. Mental institutions were very bad places (see One Flew Over the Cuckoo's Nest). Finally the pendulum started swinging the other direction starting in about the 50s (in the 60s JFK called for reform) and culminating in the 80s when Reagan effectively emptied the mental institutions (but more for budgetary reasons than any concern for the mentally ill). And now we've reached the other extreme where we're too afraid to violate the civil rights of the mentally ill so we let them stay on the streets because that's what they "want" to do.


> culminating in the 80s when Reagan effectively emptied the mental institutions (but more for budgetary reasons than any concern for the mentally ill).

“Reagan” getting credit or blame for this is largely misleading. There were a number of drivers..

Deinstitutionalizations was an important goal of the Community Mental Health Act of 1963.

Subsequently, a series of federal court rulings in the 1970s which restricted involuntary commitment and required paying patients federal minimum wage for doing work in and for institutions (like the prisons, mental institutions were slave institutions – on top of their myriad other problems – in all but name) undercut both the pipeline and the financial underpinnings of the system of institutionalization.


I think too many basically sane people are close enough to losing their minds at all times that they would fear for their own civil rights. The mentally ill on the streets are only a small sample of a spectrum.

I understand the history well enough to note that a wide swath of (also) expensive alternatives have not been tried yet, or the basically sane people mentioned above would be willing to undergo treatment that works.


Willingly wasn't necessarily their idea, that's the whole point of this thread - getting people into treatment by their own choice vs. forcing them:

> > > ... treatment should be helpful enough and sufficiently respectful of users' rights, that people who need it don't refuse it


The list of people who need help is so much longer than any one causing an event that makes it into the newspapers or anecdotes.

Why is it such a fantasy that treatment options should be appealing to the people committing themselves to them?


presumably, in order to obtain consent. non-consensually committing someone raises issues that must be addressed to prevent abuse.

I live in a state with 72 hour minimum emergency involuntary committal. (further requires a court order) this is a compromise that addresses the above concern. ideally it is enough for the patient to get on a routine of taking meds and making sure there aren't adverse reactions from them.


That’s…not a solution. That’s a goal.


These arguments make logical sense, but fall flat to me, after spending a few years watching severely mentally ill people take over neighborhoods, rob, break in, and assault the people living there. Near my home, a large man lived nearby that began attempting to sexually assault women walking to the gym or nearby shops. It became a running joke, as nobody would do anything about it. I was regularly accosted by clearly mentally ill people who would defecate anywhere and yell at anything.

That experience made decide that we're too sympathetic.

For an extreme example, look up the echo park protests. Echo park was a great place to take my kids until it was overrun by homeless and bodies started appearing. And in the name of sympathy and such, protestors attempted to prevent the clearing of the park.

https://abcnews.go.com/US/police-protesters-clash-sweep-echo...


You see I feel like I'm some bizarre moderate where I can understand both the people who want Echo park cleared and also the people who are protesting the clearing of Echo park. It's not safe for the rest of the community for them to be there, but neither has the community provided any reasonable other option for them! I've heard of stories where people have tried to get housing only to be told they wouldn't be allowed unless they got rid of their PTSD-specific service animal or some other nonsense that is most definitely illegal but they're fucking homeless dude, where are they going to get any legal rep or otherwise to fight it? But at the same time they literally shouldn't be allowed to collectively endanger the community by accosting others or anything like that. It's a bad situation all around and I think I'm living some kind of crazy town where I sympathize with everyone and think there should be a solution that benefits all parties.


That's not being moderate, that's being idealistic. You're saying, quite correctly, that there should be a better way, but in reality, people are dying in the streets next to a bus stop that kids use. The immediate problem (chaos) is absolutely a symptom of a larger systemic issue, but allowing that fact to impede solutions to the the very real immediate problem is not productive. You can do both. But to do so we have to do something.


"We have to do something, and this is something, so we have to do this". :/

Clearing doesn't work! We do sweeps all the time in SF and Seattle etc and it doesn't get rid of the homelessness problem, it just deepens the problem by throwing out the few possessions those homeless people have and removing any remaining stability they have. They will still be homeless.


What you said is true globally, but not locally. To those who live near the affected area, clearing is one of the best immediate options.

But what you said is also wrong: We can do both. We can evict unlawful camps where they infringe on the rights of others, and we can prepare better solutions. We don't need to stop one to wait for the other, no matter which one you do first.


Just doing clearing without solving the other side of the issue is an example of the classic "tragedy of the commons" where people make decisions that benefit a few people greatly while having a larger negative impact that is distributed among a much larger group of people.

While we can do both, we need to start with preparing better solutions FIRST, because if we do clearing first we make the problems we need to solve with the better solutions worse.


> we need to start with preparing better solutions FIRST

Disagree. Keep the peace first. That's basically where we'll not agree, I think. and that's ok. No sense arguing without further depth.

FWIW, I'll claim without evidence that if your daughters couldn't leave their house for fear of the man under the bridge raping them, then you might change your answer. It absolutely changed my answer.


> if your daughters couldn't leave their house for fear of the man under the bridge raping them, then you might change your answer. It absolutely changed my answer.

Quite possibly as I don't pretend to be a saint who always puts society ahead of myself. (Edit: this is the heart of the tragedy of the commons, everyone is making rational choices we can be sympathetic with but the end result is that things end up getting worse for everyone over the long term.)

However, I would do it with a heavy heart since I know that while I am protecting my (hypothetical) daughters, I am doing so at the cost of putting someone else's daughters at risk instead while also making the overall situation worse.


I respect your (hypothetical) altruism.

This isn't tragedy of the commons, because the whole of humanity does not end up worse with these actions. I'm not convinced that clearing an encampment makes the average wellbeing across humanity go down. These arguments turn a blind eye to the harms to surrounding people and the homeless involved.


> This isn't tragedy of the commons, because the whole of humanity does not end up worse with these actions.

Nothing about "tragedy of the commons" implies that the "commons" must be of global scope. The name derives from the classic example of unregulated grazing on common land in the UK.

> These arguments turn a blind eye to the harms to surrounding people and the homeless involved.

Not at all, the whole point is to reduce those harms. When you clear an encampment, the homeless person doesn't just disappear. You don't fix the problem, you just move it elsewhere and make it worse and harder to fix.


But I never agreed with impeding the forceful solution. I merely said I find it sympathetic and understandable to do so. You're misunderstanding me in the exact way where I think I'm in some crazy land where I think everyone is acting sympathetically but no one else seems to be capable of believing this. I firmly understand the absolute need for the community to try and protect its housed people, but I also acknowledge the very same community is doing so because it has no protection for its unhoused people.


> after spending a few years watching severely mentally ill people take over neighborhoods, rob, break in, and assault the people living there.

I've been thinking lately that the modern zombie genre might be influenced by this. Sort of a metaphor for what's happening in a lot of cities.


We just endured a pandemic in which we (100% of Americans) were compelled to comply with public health directives. The disease killed 0.3% of the population. I wore my mask, and a majority felt that compliance was the necessary and humane thing to do.

But some-as much as 45% of the adult population-felt very uncomfortable with having to comply, for whatever reason. But the rule was firm, and those who wouldn’t comply were shamed for their obstinance.

Over the same period, roughly 0.1% of the population died from drug overdoses, and roughly the same number are homeless with mental illness.

As a society, and morally and ethically sound individuals, we have to be consistent about what is best for public health.

Dangerous people living in squalor on public streets using dangerous drugs or failing to take the necessary medications to alleviate mental health disease is a public health problem-not an individual rights matter. It’s not fair to the people having to live near them, and it’s not fair to our society.


This is a particularly uncompassionate take, particularly with you lumping homelessness into this.

The vast majority of homeless are not homeless by choice. Homeless people turn down shelters because shelters aren't homes, and are often legitimately worse than being outside. Programs which have offered the homeless real homes, with privacy, the ability to safely store belongings and keep pets, and the ability to decorate, cook, and sleep in quiet, have not had any difficulty filling those homes, but these programs are few and far between (none exist in the US, that I know of).

The solution to homelessness is homes, period. Not shelters, homes. Nothing else will work. Mental health treatment is utterly ineffective when the patients are suffering the ongoing trauma of homelessness, and any system which places mental health as a prerequisite to having a home will not work.

As such, whatever forceful mental health treatment you're proposing as a solution to your fear of the homeless, is not going to actually solve your problem. If the homeless are removed from the streets and forcibly medicated, they'll end up in the same spot doing the same thing as soon as they're dumped back into the world without any real help.

If you actually want a solution that works, you're going to have to grow a little compassion and start trying to actually help the homeless instead of only thinking about how to keep yourself safe from the homeless.


> Homeless people turn down shelters because shelters aren't homes, and are often legitimately worse than being outside.

I keep hearing that homeless avoid shelters because of how dangerous the people are there[1]. And that’s a legitimate point. But then people completely wipe that point from their memory when they say “Just move these people to apartments, there will be no problem.”

If other homeless are saying that many of these individuals are too dangerous to be around, we shouldn’t be surprised if people who live in apartments feel the same way.

[1] https://www.npr.org/2012/12/06/166666265/why-some-homeless-c...


"...that shelters are dangerous places, that they're full of drugs and drug dealers, that people will steal your shoes, and there's bedbugs and body lice."

From your [1].

The reasoning is that dangerous people exist in homeless shelters NOT because those people are homeless, but because people can exist who want to take advantage of homeless people, whether those people are homeless themselves or not.

Your conclusion that homeless people living in apartments can cause the same reaction based on their previous homelessness and no other quality isn't a logical one.


Apartments have doors that lock and walls that isolate. That is the point. Shelters do not.


That was not original point. Also actual issues are that you are often kicked off for a day with all your possessions. You can not be there during afternoon. You can not left your crap there. Other frequent issue is that you can not lock your stuff. I dont live with homeless, but if I had to stay with dozens of non-homeless strangers I would still felt the need to lock somehow most important possessions.


> I keep hearing that homeless avoid shelters because of how dangerous the people are there[1].

Well, I didn't say that. That's part of the problem but it's not the whole problem.

In the interview you quoted, the word "dangerous" is used once:

PIRTLE: Part of the reason was, you know, the paranoia and the fear of large groups of people that comes along with schizophrenia, but part of the reason was, and I think this is more generally the case with people, is that you hear a lot of terrible things about shelters, that shelters are dangerous places, that they're full of drugs and drug dealers, that people will steal your shoes, and there's bedbugs and body lice.

And yeah, unfortunately a lot of those things are true.

It's a bit of a stretch to call that evidence of your position, but I'll grant the point and move on I guess.

The interview also says:

PIRTLE: Oh yes, there's - I don't want to say that all shelters are like that. There's a lot of very good shelters in this country. But there are a lot of big warehouses that are just places where we stick people at night and we really don't have any regard for how they live there.

...and:

PIRTLE: I spent most of my time homeless out on the street. It wasn't until the very end of my homelessness that I ended up in a shelter. And I found out that a lot of what I was afraid of was true. I never found out what a body louse was until I got into the shelter. You know, I had my shoes stolen, just like people said you get your shoes stolen, although I will say that there were three people in the shelter who offered to give me a pair of shoes after that happened.

So there is a sense of community there. I don't want to give the impression that everyone in the shelter is bad. But you have a lot of people with a lot of problems, and so when you cram them all together, you just have one big problem. That's why I'm a big fan of smaller, scattered-sized shelters, where people can get more focus on what they need to get help.

Note that the "danger" here isn't "you're going to get murdered", it's theft--a predictable consequence of not having any place to store your personal belongings when you can't actively protect them.

And then there's this part which bears reiterating: But you have a lot of people with a lot of problems, and so when you cram them all together, you just have one big problem.

Do you see why maybe putting people into apartments might actually be a partial solution to this problem?

And you'll note, I'm not actually saying we put them in apartments right next to pre-existing tenants. My actual suggestion would be to build new housing, and repurpose or rebuild unused office and retail space. There's clearly a shortage of housing, and that shortage is being maintained because it serves to inflate housing prices, making a few people rich. If there's anything there should be an excess of, it's basic needs like homes.

So it starts to sound like you're responding to a straw man argument I didn't make, based on an interview that you read very selectively.


> In the interview you quoted, the word "dangerous" is used once:

If you're familiar with the situation, you know that homeless frequently talk about the dangerous nature of shelters as a reason why they don't want to stay there. I hope that any discussion about the issue would at least be aware of that. The article I picked was just the first one that come up on Google in case people were new to the situation and didn't know much about it, but there are plenty of others you can find with even a quick search:

> Likewise, respondents said they found it hard to coexist with others battling mental health issues at the shelters and that it sometimes led to issues such as fights, which made others feel unsafe.[1].

**

> But shelter beds seldom keep pace with need. And some people, like Carver, avoid shelters even when they are available. They say they feel unsafe and uncomfortable in the shelters, or they impose rules they can’t follow.[2]

**

> They refuse to go back because they feel unsafe in them. Whether due to mere paranoia caused by an individual's unfortunate battle with mental illness or is a legitimate take on the reality of the conditions within the homeless shelter itself, the feeling of unsafety is as real as it gets. Some individuals site witnessing violence, drug solicitation, or theft as reasons it is unsafe to stay.[3] __________________

> And you'll note, I'm not actually saying we put them in apartments right next to pre-existing tenants.

That's the way it is being implemented cities trying the "housing first" approach, though, and with predictable results (long time residents having to move as there's a sharp increase in crime and violence in the building).

[1] https://www.desmoinesregister.com/story/news/local/des-moine... [2] https://www.theguardian.com/society/2022/nov/02/unhoused-peo... [3] https://caufsociety.com/why-the-homeless-refuse-help/


> If you're familiar with the situation, you know that homeless frequently talk about the dangerous nature of shelters as a reason why they don't want to stay there.

If you're familiar with the post you're responding to, you know that I didn't disagree with that. How many times are you going to continue accusing me of this straw man argument? I've already told you that's not what I'm disagreeing with.

You go on to quote a bunch of support for my assertion that shelters aren't homes. People herded into warehouses like cattle and forced into close proximity with no privacy get into fights? Why is that surprising to anyone?

> > And you'll note, I'm not actually saying we put them in apartments right next to pre-existing tenants.

> That's the way it is being implemented cities trying the "housing first" approach, though, and with predictable results (long time residents having to move as there's a sharp increase in crime and violence in the building).

There are a bunch of reasons why that's happening: among them a refusal to re-purpose office and retail spaces which would be farther from existing residential areas, and intentional poor implementations of these programs by political interests so they can say they don't work.

Failures of a poor implementation vaguely related to what I'm actually suggesting, aren't actually criticisms of my suggestion.


> As such, whatever forceful mental health treatment you're proposing as a solution to your fear of the homeless, is not going to actually solve your problem.

I have a 70 year old family friend that owns a farm, 4th generation of his family to own the farm. it butts up to the Freeway. His farm is less than 1/4 a mile outside a large (~200k) city limits on the west coast.

He has an encampment of 30 or so homeless people living on his land. (A spot set aside for nature by the county, so its wooded, not actively farmed). this is about 200 yards from his house. In a typical day, 15 or so semis' and old motorhomes pull over along the freeway offramp, to buy/sell meth. They cut down the trees, set fires to warm themselves, wander trough his property, have stolen countless tools, scrap metal, diesel fuel, etc from him. Basically a large tent/tarp city, with human waste, needles, stolen bikes/cars, (well, stolen everything) Its also caused a huge influx of rats, coyotes, and other scavengers.

The County Sheriff has told him they no longer respond to trespassing and vandalism calls, and to just file a report. (they are overwhelmed with them) His 68 year old wife will no longer ride her horse on that half of the farm, she is scared of them, and if their dogs charge at her horses again they might spook them and cause her to get really hurt.

One time, before they said no more trespassing calls, the sheriff did tell them to leave, they moved their camp from the trees, to right alongside the freeway, which is owned by the state dept of transportation. they couldn't do anything then, since it was state land, and they moved back the next week.

once they do clear out, because its private property, he is solely responsible for the cleanup costs, including the human waste, needles, stolen abandoned cars, etc. He could also be fined by the state for cutting down trees, etc, in an area that is supposed to be set aside for nature. (even though he did not do it)

I understand your ideas, And I am all for building them all homes. I am all for compassion, empathy, and helping out those that are less fortunate, and need help. But if it was funded, today, 100%, that would be 12-18 months to build the homes.

There are solutions that need to be done now. And there are solutions that need to be done long term as well. We should be doing all the things, not just waiting for the one perfect thing to be put in place.


Who is proposing that we wait, doing nothing, for a perfect solution to be put in place? I'm certainly not. I'm very in favor of harm reduction.

All I'm doing is addressing the only solution which is actually going to solve the problem in the long run. There remains a persistent refusal to talk about giving homeless people homes. Literally not a single response to my post has seriously engaged with the idea.


In support of this:

Somewhere around 53% of homeless people are employed, part or full time.

40% of people were employed in the same year they became homeless.

Definitely feels like a safety net issue and not a "homelessness is entirely a mental illness issue".

https://bfi.uchicago.edu/insight/finding/learning-about-home...


Does "free homes for the homeless" possibly work in the US without becoming "free basic homes for everyone"? It is ludicrously easy to attack politically otherwise ("you're working two jobs to make rent for you and your family, and now they want to give these people a free home that's new and nicer than your crappy old apartment!"), and you know the American right would rip it to shreds, given they already see social security/medicare as too expensive. EDIT: there's also the issue of "they don't wanna do things that way, so we're gonna give them nicer things; meanwhile, all the rest of you should keep following the laws kthx." We need to figure out how to reintegrate people into society without giving up on the ideas of that society in the first place.

From what I've looked up, places with much more established shelter programs and capacity than SF have fewer problems than SF. It makes zero sense to refuse to even start there. Personally, I would start with shelters and with programs to try to prevent homelessness in the first place; the input funnel is the key variable here, because as you mention, everything else becomes much harder after that.


> Does "free homes for the homeless" possibly work in the US without becoming "free basic homes for everyone"?

No. Free basic homes for everyone is exactly what I want.

> It is ludicrously easy to attack politically otherwise ("you're working two jobs to make rent for you and your family, and now they want to give these people a free home that's new and nicer than your crappy old apartment!"), and you know the American right would rip it to shreds, given they already see social security/medicare as too expensive.

Easy attacks have easy solutions. Nobody should have to work two jobs to make rent, and tiered aid should exist for people who aren't already homeless such that that isn't necessary (in addition to addressing income disparities). Nobody is proposing we give the homeless free new homes and give the barely-homed nothing.

> there's also the issue of "they don't wanna do things that way, so we're gonna give them nicer things; meanwhile, all the rest of you should keep following the laws kthx."

I'm not even sure this narrative is coherent. Is the implication that the homeless are lawbreakers and therefore deserve to be punished... with homelessness?

> We need to figure out how to reintegrate people into society without giving up on the ideas of that society in the first place.

No, we don't. Which idea exactly are you talking about? If there is some idea of our society that is opposed to the idea that humans deserve to have their basic needs met, I'm pretty on board with changing the idea of our society.

> From what I've looked up, places with much more established shelter programs and capacity than SF have fewer problems than SF. It makes zero sense to refuse to even start there.

Who's refusing to even start there? You won't hear any perfect solution fallacies[1] from me.

But I'm fully on board with imperfect solutions when better solutions aren't available, but your post seems to be arguing that we shouldn't even try the better solutions, because people might object. It's a weird circular argument: we're opposed to trying giving people homes because people might be opposed to it? We need to change minds, which is why I'm having this conversation.

[1] https://en.wikipedia.org/wiki/Nirvana_fallacy


Sorry if it wasn't clear, my argument is less "we shouldn't even try the better solutions, because people might object" and more "we shouldn't fight against other solutions in favor of a hypothetical that we are miles and miles away from being able to try."

I have seen protestors who draw a line in the sand at "free good housing for everyone" (sometimes piling on even more things like "abolish capitalism" for even less feasibility) and fight against any solution short of that. And the only people who would win, politically, from that are the right-wingers who want to deploy cops against the homeless and push them out of town and out of sight. Enough people start to lose patience with the lack of action that they vote with the assholes since nobody else is trying anything.

It's not all the way there, but look at the last mayoral election in Los Angeles: two candidates who were both fairly pro-police and pro-shelter and pro-encampment-clearing, despite the efforts of the more radical protestors. If those efforts were to get blocked by protests from the left, I think people would only swing further right on that issue, since both of the final candidates were already far more active on the issue in their platform than in previous elections.


> and you know the American right would rip it to shreds, given they already see social security/medicare as too expensive.

So let them complain! Might as well try and do the things we want to do. They'll find something to complain about, regardlessly. A certain tan suit comes to mind.


> Programs which have offered the homeless real homes, with privacy, the ability to safely store belongings and keep pets, and the ability to decorate, cook, and sleep in quiet, have not had any difficulty filling those homes, but these programs are few and far between (none exist in the US, that I know of).

This one is close to what you're describing:

https://www.lihihousing.org/tinyhouses

(Consider donating!)

These tiny house villages are real tiny homes, providing privacy & dignity.

And you're right about people preferring anything over a shelter:

"Some of the people we spoke with told us that if given a choice between staying in a nearby homeless shelter or spending their nights in a tent, they will choose the tent" (https://www.krem.com/article/money/economy/boomtown-inland-n...)

A tiny house in a small-by-design village is a better solution than a tent in a large encampment or shelter.


That's exactly what I'm proposing, and I'm overjoyed to see that happening in the US! Thanks for bringing it to my attention!

I'm going to do more research on their finances, but if nothing bad comes up I'll probably move a bunch of my donation budget to them.


That's exactly what needs to be built. The other thing that needs to be done is for cities to not tolerate homeless people living unsheltered in city streets or parks. Any homeless people that refuse to enter shelters in the city should be deported to these tiny home villages.


I have thought about this a great deal, so please consider my thoughtful response. Compassion is about everyone and everything. I am extremely compassionate and I live to reduce suffering for the greatest number of people, and animals. It is possible to err on the side of providing accommodation to a few, while causing grief for the many. This is a calculus that is hard to make, but it is necessary nonetheless.


Whose grief? Quantified how? Compared against what benefit provided by the "accommodation to a few"?


> In 2005, Utah adopted a 10-year plan to end chronic homelessness using a Housing First strategy. Although other areas had employed the practice of prioritizing housing for people experiencing homelessness, Utah was the first jurisdiction to adopt this strategy as part of an official plan at the statewide level. Within 10 years, the number of people experiencing chronic homelessness in the state of Utah fell by 90 percent. During this time, HASLC developed several apartment complexes for people experiencing homelessness, with its first permanent supportive housing development opening in 2007.

https://www.huduser.gov/portal/pdredge/pdr-edge-inpractice-0....


First, I agree that mental health and homelessness are serious public health problems.

We didn’t mask and isolate because 0.3% of Americans died. We did it so that only 0.3% of Americans would die.

I’m not sure how the response to the drug epidemic and the infectious respiratory pandemic could be ‘consistent’.


Please allow me to clarify. First, it is not clear that wearing masks had much if any of an effect on reducing deaths during the pandemic. The science is not definitive. Isolation was probably a much stronger factor; but again, not necessarily causative.

With respect to how the drug epidemic and the pandemic are compared: my point was that a majority of people were compelled to comply in the case of the pandemic for the greater good, so it is not unreasonable to compel a small minority of people to comply for the greater good. In both cases, those who are compelled to comply are theoretically receiving advice and services that are for their own good according to science and common sense.

I also recognize that “homelessness” is a catch-all phrase that is abused, and that roughly half of the homeless are not suffering from mental illness or drug addiction. So the solutions to these problems are distinct.

My only appeal to those reading this is to consider the big picture and to consider solutions that are best for all of society. This is a democratic approach.


I just want to make sure I'm understanding you correctly.

Are you equating wearing a small piece of cloth -- something all of us are already legally required to do outdoors -- with jailing and forced treatment of the homeless?


Are you equating abject neglect of society's responsibilities of caring for our fellow humans with freedom?


Of course not. I'm pointing out people upset with a small mandated inconvenience are completely fine with the imprisonment and forced medication of others.


That question only makes sense if you beg the question and assume that the only way to fulfill "society's responsibilities of caring for our fellow humans" is "jailing and forced treatment", otherwise it's just a rhetorical bit with no substance.

The GP's question was obviously baiting but also follows logically.


That’s your/gparent’s phrasing, not mine. I’ve actually worked in a mental hospital, and it was 100x better and more humane than the freedom to die from the elements and/or eat from garbage cans while yelling at no one in particular.


I saw far lower than 100% of Americans actually comply with public health directives, and if those who think being made to wear a piece of cloth over their face or take a vaccination is an unacceptable loss of freedom, I can only imagine the violation of being held against their will and forced to take psychotropic medication. I actually don't really disagree with your premise, but it (like solving most any problem) does not seem possible in modern America.


> We just endured a pandemic in which we (100% of Americans) were compelled to comply with public health directives.

Nonsense. Absolute, utter nonsense. I'm not sure why we are all of a sudden rewriting history.

100% of Americans were asked to comply with a range of public health directives. Actual enforcement and compulsion of the public ranged from non-existent (In most of the country) to symbolic (In a few coastal cities).

A significant fraction[1] loudly, and very prominently refused to comply. They got their way.

An even bigger fraction complied in an incredibly half-assed manner. As of today, a mere 16% of the US population has had an updated booster vaccine. Only 70% of the population has completed the first vaccination series (But hey, 81% got their first shot, so at least that's something...)

[1] Much of that same fraction, of course, has no issue with inflicting involuntary mental health treatment - because it's directed at other people.


> 100% of Americans were asked to comply with a range of public health directives.

This seems a bit of a rewrite itself. A large portion of the american work force was told get in line or find a new way to feed and house your family.

Some people like to helpfully point out that's technically not forcing anything, but it's certainly a little bit more than politely asking.


>I'm not sure why we are all of a sudden rewriting history.

Because history was being re-written in real-time, so people stopped being compliant.

People started the pandemic voluntarily washing products they brought into their homes for crying out loud. Your facts agree: 81% got the initial vaccine, because people thought it would mean something.


Many of those people even COMPARED WEARING A MASK AGAINST THEIR WILL TO THE HOLOCAUST.


I don't think I would call any of this take "moral" or "ethical", and in the future, I would suggest refraining from using those words to refer to yourself.

Homeless people are rarely dangerous. They don't want trouble because they know the moment that happens the cops will descend on them for a bit of fun. They are easy prey for others.

It's also disingenuous to suggest that mental illness is the sole cause of homelessness, or that mental illness can always be alleviated with meds. Neither are true.


Agreed. Over half of homeless people are employed. And many (most?) of those can't afford housing (and everything associated with housing) with their wages from that employment.

Wages in comparison to the cost of living is an issue we also talk about, but we never connect the two.


The problem is that there is no perfect treatment for severe mental illness. We cannot cure it. Many of these drugs have major and serious side effects, which is why so many people stop taking them.

So the only question then is what will you do with these people? Do you let them continue to deteriorate under their own agency to the point where they become violent? That's not humane to their (inevitable) victims. Do you commit them involuntarily? That's not humane to the patient themselves.

Unfortunately, someone's human rights are going to be trampled in this scenario, the only question is whose.


> The problem is that there is no perfect treatment for severe mental illness. We cannot cure it. Many of these drugs have major and serious side effects, which is why so many people stop taking them.

> So the only question then is what will you do with these people? Do you let them continue to deteriorate under their own agency to the point where they become violent? That's not humane to their (inevitable) victims. Do you commit them involuntarily? That's not humane to the patient themselves.

> Unfortunately, someone's human rights are going to be trampled in this scenario, the only question is whose.

It's true that we don't have perfect cures for many mental illnesses, but as a society we aren't even treating mental illnesses close to the best of our abilities. I'm not ready to give up treating mental illnesses and start trampling human rights when we haven't even tried giving people effective and affordable healthcare.

There's a narrative that we're trying to help people and they're not accepting help, and that's possibly true in a minority of cases, but in the vast majority of cases our society is just not doing anything for people that could reasonably be expected to work, and then we're blaming them for it.


Involuntary admission is not automatically inhumane, but you do need to be admitting people to well-run hospitals and have a system in place to protect everyone from malicious admission. Both of those things cost money.


> Do you let them continue to deteriorate under their own agency to the point where they become violent? That's not humane to their (inevitable) victims. Do you commit them involuntarily? That's not humane to the patient themselves.

The Law should take care of this person. If someone is violent, then they should have caught the attention of law enforcement and thrown in prison or put into a mental institution because they are violent. The problem is that The Law is not acting on the violent people who are homeless.


> The only guardrails that work to prevent abuse are community connections and the right to refuse.

These aren't the only guardrails that work to prevent abuse, and each has their limitations. Independent oversight and advocacy also work: in family court custody disagreements, the court appoints an advocate for the child, who has access to inspect living arrangements and gather other information to determine if the child is being abused or neglected by one or both parents. Of course these systems have limitations also, and the reality is that ALL these systems ideally would be in place.

As usual, the underlying problem is greed. For-profit healthcare means that healthcare providers will cut cost and fight regulation on anything they can get away with, and that means that oversight is lax and independent patient advocacy is absent. Until we stop trusting corporations and assuming that amoral profit-seeking will lead to good results, these problems will not be fixed.


> If people don't want treatment, we should ask what's wrong with the treatment, rather than forcing people into it. It's rarely helpful and makes things even harder down the line.

This is ridiculous.

Some people who are mentally ill cannot make informed decisions for themselves. If the voices in someone's head prevent someone from getting treatment, it's not the treatment that's the problem.


Yes, either these folks are competent to make decisions, or they are not. A significantly binary decision.

Deeming them competent to make treatment decisions but not to face consequences for their behavior has been an absolute disaster.


> Yes, either these folks are competent to make decisions, or they are not. A significantly binary decision.

Except it is not binary. "Competence" is an arbitrary threshold we place upon a spectrum and where people fall on that spectrum can vary significantly over time.

> not to face consequences for their behavior has been an absolute disaster.

They face lots of consequences, life in poverty on the street is extremely harsh and it punishes bad choices severely.


The law is reasonably clear in this area, with established precedent and procedures. Used to be followed.

Not the consequences I’m referring to, rather law enforcement.


> If people don't want treatment, we should ask what's wrong with the treatment, rather than forcing people into it. It's rarely helpful and makes things even harder down the line.

This statement only works under the assumption that the person is thinking logically. We don't ask those who are unable to exercise reason for their decisions. As an example, my infant broke her finger recently, and needed stitches and bandages and a cast. If it were up to her, she'd take the bandages off and play in the mud. Luckily, she has parents who know better despite her kicking and screaming. If only some adults were so lucky


In extreme cases mental illness manifests in violent behaviour, suicidal behaviour, etc.

Most of us, including those of us with mental illness (which is effectively everyone to some degree), don't want to live in a society in which antisocial individuals are permitted to "refuse" to be treated. Their victims do not have that same privilege.


How do you know that 'most of us' feel that way?

I definitely do want to live in such a society.


The rule of law, and non-elective incarceration for violent behaviour, are about as old as time itself.

You can remove the laws if you like, societies will simply begin self-organizing around removing antisocial elements (or removing themselves from the situation e.g. downtown decay).


I just want to point out that we have several people in this thread talking about the blatant tyranny of being asked to wear a small face covering...

...while simultaneously advocating for the state to imprison and forcibly medicate others.

It's also interesting that you value "a nice downtown" more than "liberty".


On the one hand, we have a perfectly functioning member of society being forced to wear a mask, when they don't even have a disease, for the sake of overly-anxious individuals.

On the other, we have someone who might decide to live in a random place in a tent, shit in the street, swing bricks in socks around on the trains etc.

I'm far more worried about the degenerates on my route from the train station than I ever was about coronavirus.


> I'm far more worried about the degenerates on my route from the train station than I ever was about coronavirus.

And I'm personally far more worried about the 'degenerates' who might get my immunocompromised grandfather sick, than the people I meet on my way to the bus stop. You probably would be too, if you were sick, or lived in a 'better neighbourhood', or were better at analyzing long-tail risk[1].

Unlike the people refusing to vaccinate, he doesn't have a choice in his condition. He gets to live with the selfish, ignorant decisions made by others.

[1] Contagious, preventable diseases maim and kill vastly more people every year than <mentally ill people who are refusing to take meds>[2], but for some reason, you're more scared of the latter than the former.

[2] The solution to them is a pinprick, and sometimes a day of discomfort. The solution to mental illness is often a lifetime of meds that make you either want to crawl out of your skin, or feel utterly dead on the inside, or be completely disembodied, or just plain make you suicidal. There's a good reason people refuse medication for their issues. There's no good reason for why people refuse to get vaccinated.


No-one is proposing that all mentally ill people (effectively all people) are forcibly medicated.

Only those that are an acute danger to themselves and others, degrading the world around them on a non-statistical basis.

The alternative is to imprison them.

You are engaging in a strawman here.


Valuing a nice walk over human freedom, autonomy and dignity sure is an interesting choice for a person who claims to be moral.


Dignity sure is an interesting choice of word to use to describe people who live under bridges.


> Most of us, including those of us with mental illness (which is effectively everyone to some degree), don't want to live in a society in which antisocial individuals are permitted to "refuse" to be treated. Their victims do not have that same privilege.

You're making an excellent case for mandatory vaccinations.


In the case of mandatory vaccinations, the victims are few whereas the requirement is placed on many.

In the case of acute mental illness, the victims are many whereas the requirement is placed on few.

The situations are not comparable.

I think a more reasonable analogue would be that I am making the case for mandatory isolation for sick individuals.


> In the case of mandatory vaccinations, the victims are few whereas the requirement is placed on many.

> In the case of acute mental illness, the victims are many whereas the requirement is placed on few.

No. Mentally ill people harm far fewer people than preventable infectious diseases do. COVID killed over a million people in the US in three years, and seriously injured many, many more. How many deaths can you attribute to mentally ill people, that you'd like to forcibly treat in that time? A few dozen? A few hundred?

And the 'requirement' is far more onerous and invasive in the latter case. If mental illness could be cured with two shots and a day of discomfort, you might have a leg to stand on. It can't be, which is why mandating treatment is rife with abuses, and obvious moral and medical problems.

> The situations are not comparable.

They aren't comparable because the ROI of mandating vaccinations is much better than the ROI of mandating mental health treatment.


There's about as much logic in what you're saying as "we lock up criminals, therefore we should require everyone to be vaccinated".

Regardless of the merits of vaccination, it's nonsensical to make this sort of analogy, and I have better things to do than engage with this.


It's an entirely apples to apples logical comparison. The problem is that you don't like what the 'mandate unwanted medical treatment for the benefit of society' garden path leads down towards.

You simply choose to not quantify the very real harm that unvaccinated people inflict on people around them. You assign it a value of zero, by calling it 'statistical'. It's illogical and irrational to do so, though. The harm is real, it's quantifiable, and people are suffering and dying from it.


My aunt didn't want treatment because her parents were trying to control her. So much so that she had her daughters up on the roof trying to disconnect the power lines so her parents and her ex-husband couldn't send control messages through the wires.

Sometimes people don't want treatment because they're insane.


These are all problems and we need a better solution that includes some sort of oversight over the care of these folks.

But the solution can't be that severely mentally ill people can say NO to treatment and then are allowed to basically threaten anyone on the sidewalk 24/7 and/or camp because they refuse housing.

This is just not working and the 98% of the rest of us have had enough. There needs to be a way to get them help, with oversight from someone that advocates for them, but without a mechanism where they can just say no. They are mentally ill and not competent to make these decisions.


I get it, there are people you want to disappear so you never have to look at them again. Declaring these people mentally ill and letting sanitariums kidnap them off the street for profit is very appealing.


Definitely not saying that. We just can't continue pretending that the current approach is working. They need treatment.


> There needs to be a way to get them help

Cool it with the doublespeak. If you don't let them say NO you are helping yourself and not them. This is hardly the first time I have seen calls to "get them help" when really it's all about getting rid of undesirables.

> because they refuse housing

That too should result in us investingating why they refuse that housing rather than forcing it (or worse) upon them.

> They are mentally ill and not competent to make these decisions.

And that kind of thought has lead plenty of abuse.


> That too should result in us investingating why they refuse that housing

We’re talking about people with severe mental illness. They are not able to reason effectively and rationally.


I'm sure its quite convenient to make that assumption. "They are insane so I don't need to listen to their concerns." Very current year culture.


That's flat out not true.


I’m not sure what you mean. Not being able to reason effectively is basically the definition of severe mental illness.


That's a frankly stale misconception based on old prejudice and Hollywood tropes. It's unmoored from reality.

Mental illness is not a monolith and it does not present the same way for different people.

It also doesn't mean you lose any ability to reason or understand what's being done to you.

I would highly recommend you refrain from commenting on this topic until you can correct your broader misunderstandings. Sharing misinformation and FUD helps nobody.


> Mental illness is not a monolith and it does not present the same way for different people.

I agree. Of course it isn’t. However, saying that people affected by severe mental illness are able to think clearly and rationally is almost definitionally false.

If their ability to think clearly and rationally were not afflicted, they wouldn’t be experiencing a mental disorder.

Further, just saying that I have misunderstandings, am spreading FUD, and should stop commenting without yourself providing cogent reasons why I am mistaken helps nobody.


We used to force hospitalization, and one result was the states would force hospitalize people to avoid having to pay for their benefits/etc. They would lock people up and forget about them forever.

There are plenty of examples of institutions that destroyed tons of people (some of whom were not even actually ill)!

My older brother, who is mildly bipolar (functional but can't really hold a job long term) was sued by the state of new jersey when he was a teenager to hospitalize him, because they didn't want to pay for school/etc.

The judge scolded them in the end, but that was a huge time spend, money spend, and emotional painful thing for my family that lasted years.

There are of course no perfect systems, but one of the practical problems is that there is no real part of the system that actually cares about the mentally ill, and is actually incentivized to do that.


We definitely need protections for people who are institutionalized. But we also need protection from the members of society who are being victimized by mentally unstable individuals. Many large cities seem to have no interest at all in the latter, to the point where there’s a class of unwell citizens that the laws no longer apply to. Many are threatening people daily, violently assaulting people, committing frequent theft, using the streets as a bathroom, etc., mostly with impunity, and law-abiding citizens are told to just live with it.


Sadly, yes. I have all the sympathy, but it stops the moment it gets too close to my nose ( or that of my family ). Anecdotally, my wife works in an environment that sees severe mental cases in a relatively well to do area and the numbers and stories make me mildly uncomfortable ( mostly because I think those are much worse in poverty stricken areas ). And then you have to remember people may be hesitant to just have their name added to the system ( and general distrust and lack of understanding of the rules governing it ); not to mention the social stigma that goes along with it.


I never said anything at all to disagree with what you said. People who are mentally unstable should be treated as if they're undergoing a health crisis like diabetic shock or sepsis or something like this. I am merely pointing out that the article has a major blindspot that weakens it, in that it doesn't adequately acknowledge that the healthcare system might actually be causing more harm to already unstable people due to the medical staff abusing them, and there needs to be additional guardrails or something similar to prevent further harm.


The article describes how the author's best friend murdered his fiance in a psychotic episode, while his support network stood around and praised him for his individual spirit.

The GP distinguishes between psychotics, who require institutionalizing, the mentally unwell, who need guidance, and their victims, who are dead. You glossed over the first and last category, so it's fair for the GP to point out that ideological blindspot.


I'm not writing a several thousand word essay about the best friend who murdered his fiance in a psychotic episode as an example of how psychotic patients should be forcibly institutionalized. I'm merely pointing out the essay doesn't address that institutionalization may make them worse because there isn't enough oversight to ensure the institutions are giving quality healthcare.


When it comes to mental illness, people should avoid commenting on specific cases because the details matter and only the professionals involved in those situations actually know enough about the state of these individuals to know whether or not treatment is warranted. I know "Free Britney!" is all the rage, but the Court does not order conservatorships lightly.

No one is arguing that asylums were perfect places. Far from it. There was a reason they were shut down in the 60s, but the alternative that we were promised never materialized either and the result is that we have severely mentally ill people wandering the streets now, left to their own devices. The results are all too predictable.


> I know "Free Britney!" is all the rage, but the Court does not order conservatorships lightly.

This is an assumption, and there's very limited oversight to this. That's the problem. The reason with Brittney was originally freed was that it was found she was inappropriately in conservatorship for years longer than she needed to be, and that all of the parties that should've been advocating for her were actually paid for by her estate through her parents, effectively making it so that anyone who advocated too hard for her wellbeing was eliminated from her circle. It's unknown how many more people are in this situation and, perhaps worse, we don't even know how many conservatorships exist!


An ounce of prevention is also worth a pound of cure. More important than investing resources into helping those with mental illness is preventing people from developing mental illness in the first place.

Traumatic experiences like you mentioned can be reduced by better education about what to look for in healthy relationships, or providing accessible resources to catch issues early before they become major issues. Other, more subtle, issues like neglect, poor home life (often due ti poverty, difficult family situation, etc.) would require more pervasive changes to address, but if prevent issues in society on the back end due to reduced incidence of mental illness, not to mention the improvement in quality of life for those affected, we should seriously consider those options.


I fully agree that we should be working on preventing ACES and other environmental effects that specifically have proven out to have causal effects on mental illness. But psychosis cannot be eliminated altogether, and if someone is psychotic I would both like them to be allowed back into health even if they do not give informed consent and also I would like them to not be raped, assaulted, or otherwise abused.


Definitely agree. It’s not either or, and both issues should be given attention; however I think reducing the incidence of mental illness is more fruitful than correcting the negatives of it after the fact.


The judicial system should, ideally, serve this function since both arguments for and against compulsory care can be represented and a judgement can be made.

The problem is that it is so costly financially and temporally that we can manage one judgement in years for a case rather than the greater re-evaluation frequency that is probably required for mental health.


The judicial system is far from perfect even when the people involved are free to find their own representation or are able to freely do their own research. Someone who is not allowed to even access their own finances or sign legal contracts will naturally have a much harder time finding good legal representation. Someone in an institution even more so.


Replacing one dysfunctional system for another doesn’t seem like the best option.


The challenge is you then have someone whose specialty is law making psychological / spiritual / developmental determinations.


Indeed. Its strange how people have no issue with forcing medical treatment (which carries serious side effects) on the mentally ill, while at the same time, opposing mandatory vaccinations (which carry vastly less serious side effects, and are incredibly effective at reducing injury and death from infectious diseases).

It's obvious why this hypocrisy is present. Mentally ill people are 'scary' and forcing treatment on them makes them uncomfortable, and me comfortable, it's an easy sell. But when medical treatment is forced on me, all of a sudden, my body autonomy becomes the most important thing in the world, and I'm dipping into horse paste and counting each myocarditis case. (And conspicuously neglecting the consequences of not vaccinating.)


Why are we acting like there aren’t objective evaluations for “dangerously mentally ill?” Everyone here is talking about how the justice system fails at this. Well yeah, it’s the justice system. They shouldn’t (and wouldn’t) be there in the first place.

This is a psychological problem and it would be dealt with by people who have domain knowledge. We’re not talking about hungry DAs with a political agenda or overworked public defenders not doing their job. We can and should evaluate people to determine the extent of mental illness and mandatorily treat them. Anything outside of that is passive misanthropy.


Some cases are easier than others. A guy shouts a list of conspiracies at a passing cars is probably not as dangerous as a guy who talks about thinking of hurting himself and others. Key word is probably. As I understand it, there are guidelines.

<< We can and should evaluate people to determine the extent of mental illness and mandatorily treat them.

Risky business man. I think you would need to lock up 100% of human population, because the question is always about the line of where they fall on the 'unacceptable' spectrum, who is making the decision and the societal impact of 'mandatory'.

As always, the devil is in the details.


As the article makes so plainly clear though, we cannot wait until someone is objectively dangerous for two reasons: 1 - it leaves very little time to actually intervene before something bad happens, and 2 - it removes our best chance to actually help someone. The mentally ill need to be treated when symptoms first start manifesting if we want to actually solve this problem.


> we cannot wait until someone is objectively dangerous for two reasons

We cannot not wait until someone is objectively dangerous before using state power to constrain their liberty in the interests of other people’s security, because any other course of action is arbitrary tyranny.

> The mentally ill need to be treated when symptoms first start manifesting if we want to actually solve this problem.

If we need to force people into treatment at the moment symptoms of what might or might not be mental illness that may or may not eventually lead to objective danger to other people start manifesting to solve the problem, then the cost is simply too high and we shouldn’t solve the problem.

Not all dangers in society have a mitigation that is a net benefit. Just because it would be beneficial in hindsight in the specific cases where we know from later events that it would have developed into a manifest harm does not mean that you can ignore the cost of all the cases where that isn’t the case that you would have to sweep into the dragnet in order to apply a “when symptoms first start manifesting” rule as opposed to a “objective danger” rule.


>We cannot not wait until someone is objectively dangerous before using state power to constrain their liberty in the interests of other people’s security, because any other course of action is arbitrary tyranny

Not true. There are nonviolent crimes that are still crimes and that you can still jail people for, and which the homeless commit lots of.


You're going to have tyranny either way. Either you have oppression of the mentally ill by the government, or oppression of society as a whole by the severely mentally ill who takeover public places when they become homeless, commit murders etc. The rights of a few do not always supersede the rights of the many.

I'm not saying we should involuntarily commit everyone who shows some symptoms of mental illness. I'm saying we should aim to treat those people before it becomes necessary to commit them.


> we cannot wait until someone is objectively dangerous ... it leaves very little time to actually intervene before something bad happens

I mean that feels like it's dangerously treading close to "pre-crime". I feel like it doesn't take much to extend that logic to poor rural children whose mothers are raising them in urban gang-run areas. I mean I can see the germ of the idea, but it's ripe for abuse.

https://en.wikipedia.org/wiki/Pre-crime


CPS can already take children out of homes in spite of the fact that no one has died yet in said situation. That is for good reason. Failing to act before a crime has actually been committed in many of those situations would lead to unnecessary deaths.


> CPS already takes children away from their families in spite of the fact that no child has yet died in their home, for good reason.

It does so, in theory, based on indicia of objective danger (and is not without deep and serious problems in when it does act, as well as when it does not.)

It very much does not support the position of taking action when there is neither crime nor objective danger.


Schizophrenia can be managed, not treated. Lost in all the talk about mental healthcare and drug addiction are two important topics.

(1) Medicine does not have an answer for all mental illness. Many are incurable, and only manageable.

(2) Sometimes even the management is not good enough.

My uncle is extremely intelligent. Also has schizophrenia. Like Michael... extremely intelligent, PhD (received after diagnosis), etc. It's been many years. He has kids and grandchildren, etc. But... he still breaks from time to time. He's even attempted flat out murder. There's no answer really. His wife (my aunt) can get him to calm down, as can his children. But, it's still there, despite everyone's best efforts.In my view, short of completely numbing his personality and individualism, I can't see how anyone can 'fix' it.

Further lost in our conversation as it pertains to drug abuse is the importance of not creating the problem to begin with. Schizophrenia is no joke. Several commonly available (some decriminalized) drugs can induce schizophrenia. We must do what is necessary to ensure this never happens. The mind is a terrible thing to lose.

EDIT: Also, having also worked at Bain, I do not suggest anyone work in management consulting if they want their sanity.


I think schizophrenia could be prevented… most people manifest psychosis in teenage or young adult years. There is at least a good decade before it develops where something could be done, maybe. Just worth thinking about, at least.


This is inline with what my wife thinks. She's a psychology PhD who studied schizophrenia in young adults.

The way she phrases it is that the current best guess is that schizophrenia is a developmental disease.


Knowing that it is a developmental disease does nothing to prevent / treat it. There are many diseases that we can recognize as developmental, yet do nothing to prevent (autism for example).


You're using "does nothing" to mean "doesn't automatically solve" here. Understanding how something develops gives you places to look to attempt a treatment. You don't stop sending firetrucks because some houses have burned despite firetrucks.


I'm not denying that. I'm just saying we need to formulate our laws such that they recognize that some diseases are untreatable. That means proper asylums where those who are not responding to treatment can safely live.


>Several commonly available (some decriminalized) drugs can induce schizophrenia.

I don't think this is true. Some drugs can have effects that superficially resemble schizophrenia and then doctors mistakenly "diagnose" schizophrenia.


https://pubmed.ncbi.nlm.nih.gov/30442059/

"Cannabis use doubles the risk of developing psychosis in vulnerable people."


That's just the thing. Psychosis can be a symptom of mental illness or it can be a symptom of smoking cannabis.


I think the question is whether or not smoking cannabis increases your future risk of psychosis. If it does, then it ought to be highly controlled, if not outright banned. If it does not, but can cause psychotic like symptoms during its use, then regulations should be made that it can only be indulged in in appropriate places.


By that logic we should ban peanuts, or at least highly control them.


No. drugs like LSD can cause schizophrenia after they are stopped or even after one dose in susceptible individuals.


And I think that is the myth.


I can tell you from personal experience that's not a myth. (Not me, personally, my immediate family member).

One LSD trip triggered permanent psychosis.


Umm...are you sure? Are you sure the LSD triggered "permanent psychosis"?


Yes, this is what I personally witnessed happen to an immediate family member, minus the scare quotes.

The LSD trip definitely caused psychosis and the psychosis has been permanent thus far (this was over a decade ago!). I literally saw it happen.


So when you say permanent psychosis, what are the symptoms?


Another nuance lost is, that there are many millions for which the sickness is a gift.

What becomes a conspiracy theory of the government following for one, becomes a thriller book for another, that switch to differentiate between hallucination and reality that artists have and patients dont have. My brother was quite the creative powerhouse, before the sickness took him.


My dad and his siblings are very smart (graduate degrees, doctors, all of them). However, the way my dad tells it, my uncle was exceptionally smart growing up, and I wonder if it was due to pre-schizophrenia traits (or pre-diagnosis... who knows).

Despite being asian, my dad was always 'afraid' of smart children. In his mind, schizophrenia was caused by lack of rest and relaxation. He always encouraged my brother and I to relax, and not work too hard. Apparently, it is now known that schizophrenia is correlated with sleep disorders as well.

I guess we are lucky in that my uncle has never been able to do anything wrong. He did attempt murder I suppose (in paranoid delusion), but luckily his brothers stopped him. I suppose it helps living near family and having a lot of siblings. Nowadays he's mostly limited (due to old age) to gathering apostles on the internet for his new religions. Probably the best outcome you can hope for.

I believe the biggest lesson from this article though, is that it is dangerous when we legislate based on hope. The 1950s and 60s saw the beginnings of the desire to eliminate asylums due to civil rights concerns. The 'solution' was a technology that at the time didn't exist, but which they hoped would exist after the law was passed. It is dangerous to create law while ignoring current reality, and depending on hope.


>I believe the biggest lesson from this article though, is that it is dangerous when we legislate based on hope.

Could not agree more. Self-hypnosis and can do rhetoric is a real poison when it comes to mental health. Its also very comon though, as humans can not really percieve mentally different people. We percieve other as flat copies with mirror neurons. So every person somebody else sees, is always "similar to me".

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

If that does not work out, the brain evaluates the persons actions result. If its nothing we regard as valuable, we classify the person as "stupid/lazy/etc", if it has good outcomes, we classify the person as "brilliant/genius/etc".

This inability to even percieve the other and the behaviour they are locked in eliminates alot of the possibilities for help. "I would never do that, unless im lazy. I would think really hard and snap out of it." is way to often the conclusion.


I'd add a third point about misdiagnosis. Schizophrenia is maybe more straightforward, but there are other debilitating mental illnesses that are often diagnosed incorrectly. I suppose, though, that just leads back to your 2 points, making it more likely that the medication/management don't help.


> diagnosed incorrectly

This is a tough one, because mental illness is not generally well-understood. Yes, we have diagnostic criteria, but they're all quite fuzzy, and very few kinds of mental illness take an obvious form like most physical illnesses. You can test for cancer and be certain; you can't test for depression or anxiety or PTSD or obsessive-compulsive disorder and be certain. Most mental illnesses exist on a continuum where, even if we could accurately identify their traits with any consistency, we would still be left to decide "are you depressed enough to be diagnosed?" I suppose in that sense, it's not unlike, say, prostate cancer, where the question is, "Is this bad enough to be worth treating?" But, generally speaking, you either have cancer or you don't; but with mental illness, there's no such binary, at least none that we've usefully identified for the vast, vast majority of forms of mental illness.


Yes, I agree...that's deeper into my feelings about it. By "misdiagnose", I mean there's quite a lot of slapping labels onto people and handing out the drugs that go with the label. And all done with "high confidence" language to the patient. There's sometimes the missing honesty about what an imperfect world it is.


Curious to hear your Bain war stories.


Well unlike Michael, I left after six months. I thought the job was a lot of BSing (and I decided to work at Bain after my SW eng interships which I felt did not move fast enough and had a lot of wasted time; I can be very type A and demanding for constant stimulation). There was a lot of time spent basically making things up to satisfy customers. There was also huge pressure to spend ungodly sums of money as an associate, because everyone's posing to one up the others (I'm talking about.. let's go do a birthday in Cabo every other weekend). So I had decided I didn't like it, but wanted to last at least a year.

Anyway, my colleague / mentor who's supposed to be helping me, instead tells me that I need to do better at making things up for customers essentially. It's quite the intense conversation. I can feel I'm not his favorite associate. Anyway, he ends his criticism by telling me not to jump out a window (we're on the 33rd floor).

Well, a week later, an associate at Goldman Sachs (which had an office in the same building) does indeed jump out a window.

A week later, I resigned.

All in all, it was very enlightening. I got to see how the rich really live. And most importantly, I realized they're no different than anyone else, just willing to sacrifice more. As my actual boss told me... family was for when I turned 30 (I was engaged already at the time I joined Bain). I recently began listening to 'Woke Inc' by Ramaswamy, and he has similar experiences at Goldman Sachs. Including the fake philanthropy stuff.


I find it hard to believe that expanding government power to put people in custody without a crime being committed is really the answer. Especially since the current laws would allow for a mandatory screening if the person commits a crime ("overt acts would almost always fall in that category or be rife for abuse). I think NY has already used mental health as an excuse to take away rights even when there was no danger to themself or others (retired NY police having firearms seized for having mild symptoms of depression with no risk of harm to themself or others).

There's a ton of background in this story, but very little about what the solution is, at least in detail.


Going into public and throwing filth at people, accosting them, and generally endangering the safety of other citizens is implicitly a crime by virtue of "Every civilized society in the history of man has cleaned up this behavior".

We don't need to wait around for a court to indict a person for "being a crazy homeless person". That's insanely reductive to the point of absurdity.


> Going into public and throwing filth at people, accosting them, and generally endangering the safety of other citizens is implicitly a crime

It's not just implicit -- assault is explicitly a crime, everywhere.


> Going into public and throwing filth at people, accosting them, and generally endangering the safety of other citizens is implicitly a crime

In the US, there is no such concept as “implicit crime”, but, yes, some of those things are just plain explicit crimes.

> We don’t need to wait around for a court to indict a person for “being a crazy homeless person”

If you are going to treat it as a crime, then, yes, it has all the procedural safeguards generally applicable to crime.


"We don't need to wait around for a court to indict a person for "being a crazy homeless person". That's insanely reductive to the point of absurdity."

They would be arrested based on the crime they commit, such as assault. Then the court would make a determination on their insanity plea.

Adultery and sodomy have been crimes in most civilization of history too. That doesn't mean we convict people based solely on the spirit of the law, nor ignore the principle of innocent until proven guilty.


I understand the civil liberties concerns, but you really want to treat severe mental illness as soon as possible. Earlier treatment is linked to better outcomes, lower costs, and a significantly higher chance of being reintegrated into society as a whole.


Don't forget that the third world has 2x better outcomes with regards to schizophrenia. Probably due to the fact that they have more familial support and/or less reliant on meds.

https://thecorrespondent.com/407/people-not-pills-what-the-w...


And if they don’t want to be treated?


No questions asked, no strings attached treatment offered where they are is going to need to be a national reality before this is a meaningful concern. Back here in reality the real barriers to treatment are means testing, provider burnout, arbitrary rules, general inaccessibility, cost, scheduling conflicts, etc. people want to live better lives. Their definition of better may not reflect yours or others and we need to accept that if the only person that they’re hurting is themself. Anything less is more of this tired song and dance while real people suffer because rich pearl clutchers can’t handle gay trans drug users with face tattoos or whatever getting a cent of tax money so they won’t die preventable deaths.


Not an option because severe mental illness affects us all. We already have a similar principle for other diseases that negatively affect others, e.g. tuberculosis.


Those other diseases have definitive tests. Most mental disease diagnosis are based on opinion, which is more prone to mistakes, abuse, and finality. Going through the courts provides some level of safeguard at least.


We're not nihilists so we treat them anyway against their will.

"If the rule you followed brought you to this, of what use was the rule?"


This concern isn’t really a problem for the homeless mentally ill that are the target of these schemes because they’re already committing small crimes all the time.


Then this policy change should be moot since they should be getting psychiatric treatment if their public defender is pleading insanity or looking at competency. Or are wr just adding more broken policy on top of an already broken system?


If prosecutors do not decline to prosecute, there is a process for diverting defendants who cannot be made competent to stand trial. (Note that this is also pre-trial, without being convicted of a crime.) But if no one is trying to determine if you're competent to stand trial, you wouldn't encounter that.


It's basically impossible to be homeless and not commit crimes as a matter of course, which is intentional. This will absolutely be used punitively against homeless people.


The homeless mentally ill though, specifically, are the ones usually committing extra crimes beyond mere vagrancy and squatting. I.e. the ones taking shits on bus seats and getting into drunken fights in public.


[flagged]


You're right, we can't make any efforts to make our streets safe and free of crazed, violent hobos until we've gotten rid of all polluters and warmongers first.


Seeing now how y'all talk about homeless & mentally ill people where you think they can't see you, they are right to hate us.


If they didn't shit on bus seats I would have no reason to talk about them shitting on bus seats.


I agree with you, except for the "punitively" judgement.


I had a homeless stint. I did day labor for money and parked my tent in places where it was legal for me to stay, or where I hadn't been trespassed and wasn't marked, thus it would not be illegal unless someone asked me to leave and I didn't. In many states camping on property isn't illegal unless you've been trespassed, it is posted, or it is gated off etc.

Plenty of homeless people who don't commit crime, you just don't notice them because they aren't bothering anyone.


Thanks for mentioning this. There are a lot of people who are homeless solely for economic reasons and are mostly unnoticed.


It's unfortunate that some jurisdictions are doing everything they can to make it illegal to be homeless anywhere, because I agree, lots of homeless people aren't bothering anyone.


There's also a lot of substance addiction in homelessness, and treatment centers aren't really located in places where it's legal to camp.


Most treatment addiction treatment centers, especially the more effective ones, are in-patient facilities.


I was thinking more of outpatient methadone clinics


I was on and off homeless for over a decade so I have my own experiences and opinions of this.


The alternative to this is 3 (or whatever number) strikes type laws where successive crimes, even small ones, are punished more severely.


That could be one option, but still has room for abuse. Maybe a homeless person shoplifts some candy three time. That's a felony in many states. Maybe they have a mental condition that causes them to shoplift, or maybe they were hungry. Now it's up to someone's opinion, who is likely overburdened, to decide which one it is. Either way, it's likely to result in custody, but one of those ways might involve mandated medication and a lifelong (mis)diagnosis. At least in this case it would be going through the court, and under the current laws should require some input on the part of the defendant to seek an insanity plea.


We're quite literally to the point where something like a 20-strike law, which sounds like parody, would actually be quite useful.


So you want to spend 60k/yr on prison times the homeless population of America? Because that’s what your comment suggests and there’s a litany of better options.


I have yet to see a better option in action.

It would be nice to have sufficient supply of quality mental healthcare and oversight to prevent abuse of involuntary committal, but as far as I see, that is a pipe dream.


Have we tried dragging the army Corp of engineers in to build housing?

What about a national jobs guarantee?

National healthcare that can’t bankrupt people?

I’ve met a lot of homeless people in my life, most have no use for a counselor. They’re largely uninterested in self actualization or recovery. They want safe shelter, affordable and accessible healthcare, reliable transportation, a job they can be proud of that provides for them and their family consistently. These people are gripped by despair and acting it against society at large because society has relegated them to the fringes as useless, hopeless, and expendable. Housing, healthcare, and respect for each individual human is the minimum. Just because that won’t scale does not it can be ignored. Ignoring this is how we got here. Continue ignoring it and we’ll probably see more tech bros murdered in broad daylight. We might also see the security teams of these tech bros commit a few massacres.


i also find it important to note that therapy is becoming more and more a religious practice

there are different flavors of therapy, and some may use more empirical methods than others, but there's a lot of infiltrating ideology and opinions that fight over what is and isn't science, and therefore what is and isn't empirical

but if none of this is truly empirical, the therapeutic aspects are religious

so locking people up for what are essential religious violations is way beyond illegitimate control


It does seem frighteningly easy to lose everything and be locked up.

See https://en.wikipedia.org/wiki/Rosenhan_experiment . After just one episode of telling professionals that they "heard voices", patients were diagnosed and forced to take medication despite never again showing symptoms or evidence of illness.

  Once admitted and diagnosed, the pseudopatients were not able to obtain their release until they agreed with the psychiatrists that they were mentally ill and began taking antipsychotic medications,
Even if they weren't ill... the only way to get out was to lie and say they were.


This is an interesting recent addition to the Wikipedia article.

From the summary:

> In 2019 and 2023, historians of psychiatry published evidence that the experiment is a hoax.

And following the link:

> In The Great Pretender, a 2019 book on Rosenhan, author Susannah Cahalan questions the veracity and validity of the Rosenhan experiment. Examining documents left behind by Rosenhan after his death, Cahalan finds apparent distortion in the Science article: inconsistent data, misleading descriptions, and inaccurate or fabricated quotations from psychiatric records. Moreover, despite an extensive search, she is only able to identify two of the eight pseudopatients: Rosenhan himself, and a graduate student whose testimony is allegedly inconsistent with Rosenhan's description in the article. In light of Rosenhan's seeming willingness to bend the truth in other ways regarding the experiment, Cahalan questions whether some or all of the six other pseudopatients might have been simply invented by Rosenhan.[11][12] In February 2023, Andrew Scull of the University of California at San Diego published an article[13] in the peer-reviewed journal History of Psychiatry in support of Cahalan's allegations.

Still - it’s scary how many rights you lose once you’ve been declared unwell. We might just want to start using more recent evidence since that experiment has come under question.


That’s not a very convincing rebuttal. Lack of evidence doesn’t mean it never existed. I suggest repeating the study at every in patient psych center.


The experiment being a hoax is a hoax


Not only is there a good chance this was a hoax, but it was an experiment under a different mental health regime, one with institutions and a much lower bar to commit people.

It is much different today


I suggest to try and see how it will go.


The Rosenhan experiment is now widely believed to have been a hoax.


It sounds like a great opportunity for the field to put their skin in the game and replicate it.


Living in SF for 30 years I am over, over, over severely mentally ill people killing themselves and harming others. No, they don't take their meds. The consequences mean they do need involuntary hospitalization. This has to be done with checks and balances but it has to be done.


If someone requires mental medication there should be a presumption that they shouldn’t be out loose.


> If someone requires mental medication there should be a presumption that they shouldn’t be out loose.

This is obviously excessively reductive. I don't think my friends and colleagues on adderall and setraline should be locked up when they are perfectly functional members of society.


Replace “mental” with any other word and it would be true. Navigating the US healthcare system is perplexing and depressing for anything but the most trivial of conditions, for everyone but the most wealthy.


The role of USA healthcare is to fake it. To provide the appearance of healthcare without actually providing it.

In collusion are a swarm of insurance and medical businesses. Parasites and illusionists.


Strictly speaking the US healthcare system mostly works for those who are well off enough and have good enough insurance, at least until a catastrophic or chronic condition.

But the way it is unavailable to many people and useless to many more means it should not be considered a functional system.


> the US healthcare system mostly works for those who are well off enough and have good enough insurance, at least until a catastrophic or chronic condition.

As the proud owner of several chronic conditions which are treated just fine(*) by US healthcare, I can infirm this statement (and I'm very, very far from being a fan of US healthcare...).


Guidelines | FAQ | Lists | API | Security | Legal | Apply to YC | Contact

Search: