The truth will set us free. Acknowledging the realities of untreated mental illness is the most respectful, compassionate, common-sense solution to this ever-growing crisis. Focusing on those who need the most help would be a great first step.
In my context we mandate treatment for people with mental illness so long as a tribunal (independent of the health team) agrees that 4 criteria are met. These mandates are reviewed yearly. It is then expected that the person be case managed by a community doctor plus a mental health nurse or social worker.
The 4 criteria are: having a mental illness, needing treatment for the mental illness due to risk to the person or others, lacking the capacity to make a decision about accepting treatment, and the absence of less-restrictive means to ensure ongoing treatment.
This works very well. It optimises dignity in a very difficult situation. Frequently these people can return to stable accommodation and meaningful social functioning, even if they remain without insight as to the need for ongoing medication.
The main complication is ongoing drug use. For example methamphetamines. In many cases this is really challenging even with adequate antipsychotic treatment.
EMS workers years ago in California could summon a police officer to ask to have someone committed for mental evaluation. The code in police terminology was 5150 and the police could invoke it. Possible mental cases could then be sent to the county hospital for evaluation and held for 72 hours. There were arguments against this back then and it was ACLU types that made it. One of them was that people would unfairly have elder relatives locked away so they could take control of the monies and estates. These cases were always subject to adjudication to protect the rights all of those involved. Ronald Reagan was hoodwinked by some leftist and signed legislation reducing the ability of authorities to have the mentally ill committed. That's when the homeless problem really took off. I understand he later regretted it.
Michael Shellenberger, the source of this situation is rooted in the writings and thoughts of Thomas Szasz. In 1970 his book "The Manufacture of Madness" and easy read that even politicians could understand, gave those politicians the excuse to shut down mental institutions, and to sway society to stop calling mentally ill people, mentally ill. They were not to be stigmatized. This created a situation where mental illness was not treated and those who were actually mentally ill were left to suffer on their own and find other ways to escape what was hurting their minds.
// Starting in the late 19th century, the U.S. created large psychiatric hospitals, often in the countryside, known as asylums, for the mentally ill. Asylums were a major progressive achievement because they delivered, for many decades, significantly more humane, evidence-based care to people who, until then, had often been neglected, abused, or even killed.
But by the middle of the 20th century, the reputation of psychiatric hospitals was in tatters—and deservedly so. //
Reform. If a necessary thing is performing badly, remove the bad and make it better. Instead, the progressive minds saw the buildings, decided that they looked so awful that they must have been the cause of their revulsion, destroyed them, and "liberated" everyone inside. The most pernicious flaw in the progressive outlook is probably the primal urge to destroy.
No amount of lawmaking will prevent bad stuff from happening. Consider the individual human being first, please, and then "society", if you really, absolutely cannot restrain yourself from throwing another prohibition onto the enormous pile of prohibitions already towering over us all.
My ex was schizophrenic. Dealing with it beat me to a pulp, mentally and emotionally.
And yet my ordeal was a picnic compared to the people I met in the support meetings. Mostly parents of teen and young-adult sons who refused to take their meds.
How much do you want to bet that these ACL Useless lawyers live in the suburbs where they don't have to deal with or even see the homeless mentally ill? I've always loathed the ACLU, they're a scourge and the source of so many problems in our society. They have blood on their hands.
Outstanding article, again underscoring knee jerk ideology is almost never right. The ACLU is dead wrong on this issue and doing a grave disservice to our community, not to mention the very people they claim to serve.
Great article on a topic that shouldn't be viewed as a partisan issue (though it will be construed as such by a subset of commenters who can't help but blame everything on "the left").
A few points missing here. First, the funds used to support asylums were supposed to be transferred to Community Mental Health Centers when the asylums were closed. That did not happen, partly out of the belief that the new antipsychotics would make community living feasible, but also to save $. Reagan was instrumental in finally overturning the Mental Health System Act. You can thank Republicans for nixing funding for serious mental illness. Second, in 1999 the Supreme Court ruled in Olmstead v LC that the mentally ill could not be segregated because it was discrimination; the mentally ill had a right to be integrated into the community. You can thank a progressive court for that. Third, just because a mentally ill person has a guardian or conservator does NOT mean they can be made to take their medication. Besides being impossible in a practical sense, most state guardianship laws would probably not authorize such an action.
The real issue is that there are neither laws nor funding to support institutionalizing the forensic mentally ill. They cycle through jail and the courts but there has never been the public will to demand they are kept off the streets and retained in a forensic treatment facility with evidence-based care. SAMHSA can fund a few community-based FACT programs but they are not adequate to the level of need. Olmstead will have to he challenged at some point.
It wasn't "Reagan" it was the 1975 O'Connor v. Donaldson, 422 U.S. 563, was a landmark decision of the US Supreme Court in mental health law ruling that a state cannot constitutionally confine a non-dangerous individual who is capable of surviving safely in freedom by themselves or with the help of willing and responsible family members or friends. The state mental hospitals were still operating under Reagan, but once this terrible SC decision went into law, it essentially closed the institutions.
Thank you, I'm so sick of liberals blaming any and every social ill on something Reagan did 40 years ago. The Democrats have been in power multiple times in the intervening years and could have rectified it if they chose. Maybe there's blame to go around, but ultimately it was these terrible court decisions (resulting from lawsuits by ACLU and the like) that brought us to where we are now. And the ultimate irony is that these people ARE, evidently, a danger to themselves and others, as we are seeing every day. They are only nondangerous on the outside IF they take their medication as they're supposed to, which they don't. And most don't actually have "willing and responsible family members" to look after them, or if they do, they are helpless to do so as described in this essay.
We're still in shock. Alleged perpetrator a mentally disturbed former student.
This phenomenon is a convergence of trends enabled by ideologues of various stripes: overly easy access to guns is one obvious aspect, constantly harped on by the media. But there are other aspects that the media, in its quest to spoon feed us "correct" thinking, rarely or never mention.
One is that many or most such crimes are committed with weapons illegally bought, imported, or assembled from illegally imported parts. The police are well-aware of such things, but, hey, no one listens to people who actually know something. Physical tracing of weapons, not just licensing the owner, is the right answer, but only minority of states do this.
The "illegally imported" part will never be properly presented in the media, because it's a direct result of the anarchy on our borders, especially the southern borders. This used to be a united, bipartisan turning away from reality in the 1990s and 2000s, but the Republicans, to their great credit, have made it an legitimate issue, as much as the media tries to suppress it. The criminality at the border isn't just a matter of smuggling people and drugs. It's also smuggling weapons and weapon parts.
And finally, we have the mental illness piece, as Shellenberger has done so well to document.
One other item, and this puts me in a kind of trilemma.
I have had a long-standing sympathy for treating marijuana just like tobacco - the biggest reason being “How can one ban a plant?”
I do wonder, though, whether the use of marijuana by people with underlying mental illness is amplifying underlying paranoid ideations. Not to mention some of the vape products with synthetic forms of THC.
On the third hand, if we were to restrict the use by people “vulnerable to its effects,” that may well get used in an invidious way.
I was in Denver last week for a conference, last time it was held there was 2005.
The city has changed completely, i looked forward to this trip, i wont in the future. 16th downtown is simply awful with deranged drug addicts everywhere, no different than sanfrancisco.
What is the difference from 2005? Denver decriminalized pot at some point, drawing in these people from all over.
People can say that is just correlation, and it is, but its my observation.
I won't be going back to Denver for fun any time soon.
One issue may also be that it is in the interest of in-patient psychiatric institutions to hold the people they have.
The dynamic may be thus: a person ill enough to require in-patient care makes it into one of the few beds; the person stabilizes, but doesn’t want to go back to the stresses of street life and the tyranny of command hallucinations, so the person perhaps plays up their symptoms; and here’s the key, the staff has an interest in keeping stable people they know and is able to get along with the others in the facility instead of bringing in someone new, and is thus willing to endorse the person’s self-report of their symptoms.
Our first crisis is luxury beliefs of the elite (our virtuous betters).
The truth will set us free. Acknowledging the realities of untreated mental illness is the most respectful, compassionate, common-sense solution to this ever-growing crisis. Focusing on those who need the most help would be a great first step.
In my context we mandate treatment for people with mental illness so long as a tribunal (independent of the health team) agrees that 4 criteria are met. These mandates are reviewed yearly. It is then expected that the person be case managed by a community doctor plus a mental health nurse or social worker.
The 4 criteria are: having a mental illness, needing treatment for the mental illness due to risk to the person or others, lacking the capacity to make a decision about accepting treatment, and the absence of less-restrictive means to ensure ongoing treatment.
This works very well. It optimises dignity in a very difficult situation. Frequently these people can return to stable accommodation and meaningful social functioning, even if they remain without insight as to the need for ongoing medication.
The main complication is ongoing drug use. For example methamphetamines. In many cases this is really challenging even with adequate antipsychotic treatment.
EMS workers years ago in California could summon a police officer to ask to have someone committed for mental evaluation. The code in police terminology was 5150 and the police could invoke it. Possible mental cases could then be sent to the county hospital for evaluation and held for 72 hours. There were arguments against this back then and it was ACLU types that made it. One of them was that people would unfairly have elder relatives locked away so they could take control of the monies and estates. These cases were always subject to adjudication to protect the rights all of those involved. Ronald Reagan was hoodwinked by some leftist and signed legislation reducing the ability of authorities to have the mentally ill committed. That's when the homeless problem really took off. I understand he later regretted it.
Michael Shellenberger, the source of this situation is rooted in the writings and thoughts of Thomas Szasz. In 1970 his book "The Manufacture of Madness" and easy read that even politicians could understand, gave those politicians the excuse to shut down mental institutions, and to sway society to stop calling mentally ill people, mentally ill. They were not to be stigmatized. This created a situation where mental illness was not treated and those who were actually mentally ill were left to suffer on their own and find other ways to escape what was hurting their minds.
Finally, an article that doesn't put all the blame on Ronald Reagan.
// Starting in the late 19th century, the U.S. created large psychiatric hospitals, often in the countryside, known as asylums, for the mentally ill. Asylums were a major progressive achievement because they delivered, for many decades, significantly more humane, evidence-based care to people who, until then, had often been neglected, abused, or even killed.
But by the middle of the 20th century, the reputation of psychiatric hospitals was in tatters—and deservedly so. //
Reform. If a necessary thing is performing badly, remove the bad and make it better. Instead, the progressive minds saw the buildings, decided that they looked so awful that they must have been the cause of their revulsion, destroyed them, and "liberated" everyone inside. The most pernicious flaw in the progressive outlook is probably the primal urge to destroy.
No amount of lawmaking will prevent bad stuff from happening. Consider the individual human being first, please, and then "society", if you really, absolutely cannot restrain yourself from throwing another prohibition onto the enormous pile of prohibitions already towering over us all.
My ex was schizophrenic. Dealing with it beat me to a pulp, mentally and emotionally.
And yet my ordeal was a picnic compared to the people I met in the support meetings. Mostly parents of teen and young-adult sons who refused to take their meds.
How much do you want to bet that these ACL Useless lawyers live in the suburbs where they don't have to deal with or even see the homeless mentally ill? I've always loathed the ACLU, they're a scourge and the source of so many problems in our society. They have blood on their hands.
Outstanding article, again underscoring knee jerk ideology is almost never right. The ACLU is dead wrong on this issue and doing a grave disservice to our community, not to mention the very people they claim to serve.
Great article on a topic that shouldn't be viewed as a partisan issue (though it will be construed as such by a subset of commenters who can't help but blame everything on "the left").
A few points missing here. First, the funds used to support asylums were supposed to be transferred to Community Mental Health Centers when the asylums were closed. That did not happen, partly out of the belief that the new antipsychotics would make community living feasible, but also to save $. Reagan was instrumental in finally overturning the Mental Health System Act. You can thank Republicans for nixing funding for serious mental illness. Second, in 1999 the Supreme Court ruled in Olmstead v LC that the mentally ill could not be segregated because it was discrimination; the mentally ill had a right to be integrated into the community. You can thank a progressive court for that. Third, just because a mentally ill person has a guardian or conservator does NOT mean they can be made to take their medication. Besides being impossible in a practical sense, most state guardianship laws would probably not authorize such an action.
The real issue is that there are neither laws nor funding to support institutionalizing the forensic mentally ill. They cycle through jail and the courts but there has never been the public will to demand they are kept off the streets and retained in a forensic treatment facility with evidence-based care. SAMHSA can fund a few community-based FACT programs but they are not adequate to the level of need. Olmstead will have to he challenged at some point.
It wasn't "Reagan" it was the 1975 O'Connor v. Donaldson, 422 U.S. 563, was a landmark decision of the US Supreme Court in mental health law ruling that a state cannot constitutionally confine a non-dangerous individual who is capable of surviving safely in freedom by themselves or with the help of willing and responsible family members or friends. The state mental hospitals were still operating under Reagan, but once this terrible SC decision went into law, it essentially closed the institutions.
Thank you, I'm so sick of liberals blaming any and every social ill on something Reagan did 40 years ago. The Democrats have been in power multiple times in the intervening years and could have rectified it if they chose. Maybe there's blame to go around, but ultimately it was these terrible court decisions (resulting from lawsuits by ACLU and the like) that brought us to where we are now. And the ultimate irony is that these people ARE, evidently, a danger to themselves and others, as we are seeing every day. They are only nondangerous on the outside IF they take their medication as they're supposed to, which they don't. And most don't actually have "willing and responsible family members" to look after them, or if they do, they are helpless to do so as described in this essay.
Apropos: this victim was a college friend:
https://www.wildcat.arizona.edu/article/2022/10/n-meixner-family-update
We're still in shock. Alleged perpetrator a mentally disturbed former student.
This phenomenon is a convergence of trends enabled by ideologues of various stripes: overly easy access to guns is one obvious aspect, constantly harped on by the media. But there are other aspects that the media, in its quest to spoon feed us "correct" thinking, rarely or never mention.
One is that many or most such crimes are committed with weapons illegally bought, imported, or assembled from illegally imported parts. The police are well-aware of such things, but, hey, no one listens to people who actually know something. Physical tracing of weapons, not just licensing the owner, is the right answer, but only minority of states do this.
The "illegally imported" part will never be properly presented in the media, because it's a direct result of the anarchy on our borders, especially the southern borders. This used to be a united, bipartisan turning away from reality in the 1990s and 2000s, but the Republicans, to their great credit, have made it an legitimate issue, as much as the media tries to suppress it. The criminality at the border isn't just a matter of smuggling people and drugs. It's also smuggling weapons and weapon parts.
And finally, we have the mental illness piece, as Shellenberger has done so well to document.
One other item, and this puts me in a kind of trilemma.
I have had a long-standing sympathy for treating marijuana just like tobacco - the biggest reason being “How can one ban a plant?”
I do wonder, though, whether the use of marijuana by people with underlying mental illness is amplifying underlying paranoid ideations. Not to mention some of the vape products with synthetic forms of THC.
On the third hand, if we were to restrict the use by people “vulnerable to its effects,” that may well get used in an invidious way.
I was in Denver last week for a conference, last time it was held there was 2005.
The city has changed completely, i looked forward to this trip, i wont in the future. 16th downtown is simply awful with deranged drug addicts everywhere, no different than sanfrancisco.
What is the difference from 2005? Denver decriminalized pot at some point, drawing in these people from all over.
People can say that is just correlation, and it is, but its my observation.
I won't be going back to Denver for fun any time soon.
What a mess.
One issue may also be that it is in the interest of in-patient psychiatric institutions to hold the people they have.
The dynamic may be thus: a person ill enough to require in-patient care makes it into one of the few beds; the person stabilizes, but doesn’t want to go back to the stresses of street life and the tyranny of command hallucinations, so the person perhaps plays up their symptoms; and here’s the key, the staff has an interest in keeping stable people they know and is able to get along with the others in the facility instead of bringing in someone new, and is thus willing to endorse the person’s self-report of their symptoms.
I think I would do the same in their shoes.